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Nervous  and  Mental  Disease  Monograph  Series  No.  17 


Freud's  Theories  of  the 
Neuroses 


By 

DR.  EDUARDJHJTSCHMANN 

of  Vienna 


New  York 
1913 


ANNOUNCEMENT 


Nd.  1. 

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Nervous  and  Mental  Disease  Monograph 
Series,  No.  17 


FREUD'S  theories  OF  THE 
NEUROSES 


BY 

DR.  EDUARD  HITSCHMANN 

of  Vienna 


Authorized  Translation  by 

DR.  C.  R.  PAYNE 

Westport,  N.  Y. 


With  an  Introduction  by  Ernest  Jones,  M.D.,  M.R.C.P., 

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Copyright,  1913,  by 
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m 

170 

1^(3 


INTRODUCTION 

BY 

Ernest  Jones,  M.D.  (London),  M.R.C.P.  (London), 

Associate  Professor  of  Psychiatry,  University  of  Toronto;  Secretary 
OF  THE  American  Psycho-Analytic  Association 

Dr.  Hitschmann  has  in  this  volume  undertaken  an  important 
task,  namely,  a  synthetic  presentation  of  the  Freudian  theory.  It 
will  on  all  sides  be  acknowledged  that  the  need  for  this  has  long 
been  felt,  the  reason  being  that  it  is  exceedingly  difficult  properly 
to  grasp  the  significance  of  the  theory  from  the  reading  only  of 
disconnected  fragments,  which  taken  in  themselves  often  present 
an  appearance  that  is  far  from  convincing. 

The  especial  difficulty  inherent  in  any  attempt  to  render  a 
connected  description  as  is  here  given  lies  in  the  fact  that  the 
Freudian  theory  represents  not  a  fixed  philosophic  doctrine  but 
a  growing  body  of  science.  Strangely  enough  this  has  sometimes 
been  made  a  source  of  reproach  to  Professor  Freud,  as  indicating 
a  fluctuating  change  and  lack  of  stability  in  his  conclusions.  It 
is  certainly  true  that  during  the  gradual  evolution  of  his  methods 
and  conclusions,  an  evolution  which  is  still  in  progress,  he  has 
been  led  to  introduce  various  modifications  into  his  earlier  views. 
These  have  always  been,  however,  of  the  nature  of  amplifications 
rather  than  of  retractions,  increasing  experience  having  shown 
him  that  some  of  his  earlier  views  were,  though  correct  so  far  as 
they  went,  yet  incomplete  and  at  times  imperfectly  oriented. 

This  very  evolution  is  surely  evidence  in  itself  that  the  conclu- 
sions reached  are  based  on  definite  data  of  experience,  and  repre- 
sent no  subjective  opinions  of  the  author;  a  theory  of  such  novel 
and  intricate  matters  as  unconscious  mental  processes  should,  on 
the  contrary,  arouse  a  justifiable  suspicion  were  it  promulgated 
as  being  complete  and  perfect  from  its  inception.  The  further 
consideration  has  to  be  weighed  that  the  field  of  Professor  Freud's 
investigations  has  undergone  a  remarkable  widening  in  the  course 
of  years.     Confined  at  first  to  the  study  of  the  neuroses,  it  became 

iii 


IV  INTRODUCTION 

extended  first  to  the  subject  of  normal  dream  life,  of  the  processes 
underlying  the  production  of  wit,  and  the  development  and  varia- 
tion of  the  instinct  of  sex.  In  the  past  eight  years  it  has  been 
further  extended  so  as  to  comprise  on  the  one  hand  various  devi- 
ations from  the  normal,  such  as  criminality,  certain  psychoses, 
failures  in  mental  functioning  with  healthy  people,  the  nature  and 
origin  of  sexual  perversions,  and  on  the  other  hand  an  increasing 
number  of  more  normal  manifestations,  such  as  the  source  of 
literary  and  artistic  inspiration,  the  evolution  of  language,  the 
structure  and  meaning  of  religious,  mythological  and  superstitious 
beliefs,  and  the  sources  of  many  other  human  interests  and  activi- 
ties, encroaching  thus  in  ever  widening  circles  on  the  domain  of 
normal  psychology.  These  last  named  extensions,  Dr.  Hitsch- 
mann  has  here  for  the  first  time  given  a  connected  account  of, 
one  which  no  doubt  would  have  been  less  brief  had  not  the  main 
purpose  of  the  book  been  a  medical  one ;  those  who  are  interested 
in  these  important  aspects  of  psycho-analysis  may  be  referred  to 
a  special  journal,  Imago,  which  is  devoted  to  the  non-medical 
applications  of  the  subject.  When  one  works  systematically  over 
the  apparently  disconnected  fields  here  mentioned,  one  realizes 
more  and  more  both  the  breadth  and  the  unity  of  the  fundamental 
conceptions  that  follow  from  psycho-analytic  investigations.  They 
constitute  an  organic  whole,  and  it  would  seem  that  the  time  is 
now  ripe  for  a  presentation  of  them  as  such. 

In  carrying  out  this  task,  Dr.  Hitschmann  has  been  singularly 
successful.  Being  in  near  personal  touch  with  Professor  Freud 
himself  and  also  having  at  his  disf>osal  an  extensive  psycho- 
analytic experience,  he  is  in  a  position  to  render  an  especially 
faithful  presentation  of  both  the  theory  and  the  practice  of  the 
subject.  He  has  subordinated  his  personal  views  and  striven  to 
reproduce  Professor  Freud's  own  as  exactly  as  possible,  making 
indeed  lengthy  quotations  from  the  latter's  writings  so  as  to  fur- 
nish an  additional  safeguard  against  any  deflections.  The  book 
should  therefore  be  invaluable  to  those  who  contemplate  making 
a  serious  study  of  this  important  subject,  and  should  serve  as  a 
useful  introduction  to  more  detailed  and  special  publications. 

When  Dr.  Hitschmann  asked  me  to  suggest  the  name  of  a 
translator  for  his  book,  I  must  confess  that  I  felt  at  a  considerable 
loss,  for  it  was  clear  to  me  that  the  task  would  be  no  easy  one. 


INTRODUCTION  V 

German  is  a  harder  language  to  translate  from  than  French,  and 
as  most  of  the  sentences  have  to  be  entirely  reconstructed,  the 
translator  must  have  a  thorough  knowledge  both  of  German  and 
of  the  subject-matter,  especially  so  in  such  a  book  as  the  present 
one  where  so  much  material  is  tightly  packed  into  a  relatively 
small  space.  Further,  not  only  had  English  equivalents  to  be 
found  for  the  new  terms  that  inevitably  accompany  new  ideas, 
but  so  much  of  the  thought  was  novel  and  strange  that  in  order 
to  make  the  translation  intelligible  especial  care  had  to  be  taken 
in  couching  the  language  in  an  unambiguous,  lucid  and  accurately 
grammatical  form,  a  responsibility  not  always  realized  by  trans- 
lators of  scientific  works.  I  had  the  good  fortune,  however,  of 
being  able  to  enlist  the  energies  of  Dr.  Payne,  who  has,  as  I  know 
from  a  personal  acquaintance  with  his  work,  a  thorough  knowl- 
edge and  understanding  of  psycho-analysis  and  whose  care  in 
rendering  the  precise  meaning  of  the  original  combined  with  a 
rare  happiness  of  expression  will  commend  itself  to  all  his  readers. 
Dr.  Payne  has  further  enriched  the  book  with  a  number  of  foot- 
notes that  elucidate  particularly  difficult  passages  in  the  text,  and 
has  added  bibliographical  references  to  some  of  the  rapidly  accu- 
mulating literature  in  English.  May  his  translation  win  the 
success  it  is  justly  entitled  to. 

Ernest  Jones. 


PREFACE 

The  motives  that  led  me  to  believe  there  is  a  need  for  a  sum- 
mary of  the  Freudian  investigations  have  only  been  strengthened 
during  its  preparation. 

The  book  is  intended  to  serve  as  an  introduction  as  well  as  an 
incentive  to  the  study  of  Freud's  works  and  the  application  of  the 
psycho-analytic  methods ;  it  aims  at  separating  from  the  ranks  of 
the  indifferent  and  antagonistic  those  whose  position  is  due  to 
insufficient  or  erroneous  information;  finally  it  is  desired  that 
this  book  by  pointing  out  the  unsolved  problems  of  the  theory  may 
further  their  solution. 

Later  editions  will  have  to  take  into  consideration  the  progress 
or  modifications  as  well  as  the  new  views  arising  from  them.  I 
am  greatly  indebted  to  Professor  Freud  for  his  revision  and  many 
suggestions  and  to  Dr.  O.  Rank  for  his  collaboration  in  prepar- 
ing the  book. 

Dr.  Eduard  Hitschmann. 

Vienna, 

Autumn,  1910. 


vu 


TABLE  OF  CONTENTS 

Introduction  to  the  English  Edition  by  Dr.  Ernest  Jones iii 

Introduction    i 

Aim  and  Scope  of  the  Book.    Adherents  and  Opponents,    db- 

jections.    Objections  to  the  Theory.    Attempt  at  Refutation  and 

Explanation  of  Them. 

CHAPTER  I 

General  Theory  of  the  Neuroses  7 

Freud's  Field  of  Work.  General  Pathology.  Classification 
of  the  Neuroses.  Course  of  Development  of  Freud's  Theory  of 
the  Neuroses.  General  Etiology.  Role  of  Sexuality  and  Heredity. 
The  Psycho-Sexual  Constitution.  Cultural  Sexual  Morality. 
Reference  to  the  Therapy. 

CHAPTER  II 
The  True  Neuroses  15 

A.  Neurasthenia.     Clinical  Picture.     Etiology.     Prophylaxis 
and  Therapy.    B.  Anxiety-Neurosis.    Symptomatology.    Etiology. 
■    Theory.    C.  Refutation  of  the  Objections  to  the  Sexual  Etiology 
of  the  True  Neuroses. 

CHAPTER  III 
The  Sexual  Instinct  31 

Existence  and  Significance  of  Sexuality  in  Children.  Opposi- 
tion to  the  Acceptance  of  this  Discovery.  The  Sexual  Theory: 
A.  Infantile  Sexuality:  i.  Sexuality  of  the  Suckling.  2.  Sexuality 
in  Children.  3.  Changes  at  Puberty.  B.  Deviations  of  the  Sexual 
Instinct:  Inversion,  Perversion,  Fetichism,  Sadism,  Masochism, 
Exhibitionism,  etc.  C.  Sexuality  of  Neurotics.  Confirmation  of  the 
Theory  by  Analysis  of  Neuroses  of  Children.  Infantile  Sexual 
Theories.     Nuclear  Complex  of  the  Neuroses. 

CHAPTER  IV 
The  Unconscious   50 

Consciousness  and  the  Unconscious.  Common  Meaning  of 
Unconscious.  Hypnosis  and  Double  Consciousness.  The  Uncon- 
scious in  Hysteria.  Resistance  and  Repression.  Genesis  and  Con- 
tent of  the  Real  Unconscious.  The  Complex.  The  Free  Asso- 
ciation. The  Association  Experiment.  Determinism  of  All 
Mental  Processes.  The  Phenomena  of  the  Unconscious  in  the 
Psychopathology  of  Everyday  Life.  The  Unconscious  in  Wit  and 
Dream  Formation. 

IX 


X  CONTENTS 

CHAPTER  V 

The  Dream    60 

Chief  Characteristics  of  the  Dream:  Wish-fulfillment,  Sexual 
Erotic  Content.  The  Dream  Sources.  The  Dream  Distortion 
(manifest  and  latent  content).  The  Dream-Making.  Interpreta- 
tion Technique:  (a)  by  Symbolism,  (&)  by  Associations.  Tech- 
nical Rules.    Typical  Dreams. 

CHAPTER  VI 

Hysteria    75 

Freud's  Position  in  the  Theory  of  Hysteria.  Repression  and 
Conversion.  Sexuality  and  Infantilism.  The  Hysterical  Mind. 
The  Hysterical  Symptom:  Its  Somatic  and  Psychic  Foundations. 
The  Hysterical  Phantasies.  The  Hysterical  Attack.  Nervous  Dis- 
turbances. Neurotic  Anxiety  (Anxiety-Dream,  Anxiety-Hysteria, 
Phobia).    Concerning  the  Psychoses, 

CHAPTER  VII 

The  Obsessional  Neurosis  100 

Relation  to  Hysteria.  Substitution  Instead  of  Conversion. 
Characteristic  Obsession.  Nature  and  Mechanism  of  the  Obses- 
sional Neurosis  (1896).  Remarks  on  a  Case  of  Obsessional 
Neurosis  (1909).  Significance  of  the  Instinct  in  Life  (Sadism). 
Love  and  Hate;  Obsession  and  Doubt.  Mechanism  of  Distor- 
tion.   Some  Mental  Peculiarities  of  the  Obsessed. 

CHAPTER  VIII 

Psycho-analytic  Method  of  Investigation  and  Treatment 114 

Its  Peculiarity  (Specific  Therapy).  History  of  the  Develop- 
ment of  This  Method.  General  Technique.  Art  of  Interpreta- 
tion. Indications  and  Contra-indications.  The  Transference. 
Refutation  of  the  Objections  to  the  Method. 

CHAPTER  IX 

General  Prophylaxis  of  the  Neuroses  135 

Cultural  Sexual  Morality.  Sexual  Education.  Sexual  En- 
lightenment 

CHAPTER  X 

Application  of  Psycho-analysis  142 

Significance  of  Psycho-analysis  for  Medicine.  Significance 
for  the  Psychology  of  Normal  Individuals  and  for  Normal  Psy- 
chology (Unconscious,  Dream,  Wit).  Psychopathology  of  Every- 
day Life.  Elucidation  of  the  Psychology  of  Psychopaths,  Crimi- 
nals, Artists,  Poets,  Geniuses  (Characterology).  Significance  for 
the  History  of  Culture  and  Folk  Psychology. 

Chronological  Review  of  the  Freudian  Writings  150 

References  to  the  Publications  in  English  153 


FREUD'S  THEORY  OF  THE  NEUROSES 


INTRODUCTION 

Aim  and  Scope  of  the  Book.  Adherents  and  Opponents.  Objections 
and  Opposition  to  the  Theory.  Attempt  at  Refutation  or  Explanation 
of  Them. 

The  following  condensed  presentation  of  the  present  status  of 
Freud's  theory  of  the  neuroses  is  justified  in  the  first  place  by 
the  difficulty  of  the  subject,  the  constantly  increasing  extent  of 
the  publications  dealing  with  it  and  the  fact  that  the  lack  of  a 
systematic  arrangement  of  Freud's  writings  has  made  the  first 
perusal  and  study  of  them  a  hard  task.  Freud  has  never  pre- 
tended to  offer  a  completely  elaborated  theory  of  the  neuroses; 
indeed  he  could  not  have  done  so,  since  he  proceeded  from  prac- 
tical experience  which  of  necessity  could  only  develop  and  deepen 
by  degrees.  A  theory,  complete  and  well  rounded  at  the  begin- 
ning, could  only  be  the  product  of  speculation,  which  might  indeed 
be  suitable  for  a  philosophical  system  but  not  for  a  medical  study. 
Nevertheless,  the  foundation  and  framework  of  the  theory  are 
already  erected  so  that  it  is  time  to  attempt  a  provisional  review 
of  the  whole.  It  is  obvious  that  this  synthetic  presentation  avoids 
either  filling  in  or  concealing  the  necessary  gaps ;  on  the  contrary, 
it  will  call  attention  to  them  and  thus  point  out  the  problems  still 
to  be  solved.  The  book  is  meant  to  be  purely  a  review ;  it  there- 
fore uses  many  of  Freud's  own  words  and  has  especially  endeav- 
ored to  place  the  empirical  foundations  of  his  investigations  in  the 
foreground.  It  has  in  view  the  arousing  of  interest  in  the  study 
and  examination  of  this  important  method  among  distant  circles 
of  medical  men  both  in  the  clinic  and  in  private  practice,  and 
hopes  in  this  way  to  be  able  to  show  the  general  validity  of  it. 
Where,  but  a  short  time  ago  only  a  small  band  of  zealous  col- 
leagues were  gathered  around  Freud,  now  in  recent  years  the 
Freudian  doctrine  has  found,  especially  in  foreign  countries,  an 


2  freud's  theory  of  the  neuroses 

echo  of  agreement  and  a  group  of  influential  adherents.^  Still, 
wide  circles  of  the  medical  profession  either  remain  indifferent 
or  are  led  astray  and  alarmed  by  the  extreme  attacks  of  certain 
fanatical  opponents.  It  is  imperative,  therefore,  to  begin  by 
exposing  the  motives  which  lie  at  the  bottom  of  so  much  of  the 
opposition  to  an  unprejudiced  examination  of  these  new  and 
original  conceptions,  at  the  same  time  refuting  some  objections 
which  often  enough  arise  from  only  an  incomplete  understanding 
of  the  theories  which  they  oppose. 

Naturally,  one  can  only  do  justice  to  the  Freudian  doctrines, 
which  have  in  no  way  been  evolved  from  theories  but  slowly  de- 
veloped from  painfully  acquired  experience,  when  he  has  tried  out 
in  practice  the  method  of  mental  investigation  (psycho-analysis) 
derived  from  them.  The  difficulty  which  is  experienced  in 
attempting  this  has  many  causes.  In  the  first  place,  it  may  be 
explained  by  the  fact  that  for  the  present  generation  of  physicians 
educated  in  the  chemico-anatomico-pathological  school  it  is  almost 
impossible  to  allow  a  proper  place  to  psychic  causes  of  disease. 
It  is  customary  to  be  satisfied  with  the  hereditary  and  constitu- 
tional theories  of  the  neuroses.  By  far  the  greatest  and  most 
universal  opposition  raised  against  the  Freudian  doctrines  has 
been  because  of  the  disclosure  of  an  unfailing  sexual  agency  in 
the  causation  of  neurotic  manifestations.  Here  the  resistance,  a 
normal  one,  lies  in  the  nature  of  the  thing  itself,  since  healthy  and 
slightly  neurotic  individuals  are  inclined  for  intelligible  reasons 
to  deny  the  paramount  importance  of  sexuality:  the  healthy, 
because  it  constitutes  no  problem  for  them;  the  others  because  of 
their  unconsious  need  to  spread  a  veil  over  their  own  weaknesses. 

Unfortunately,  physicians  in  their  personal  relation  to  the  ques- 
tion of  sexual  life  have  not  been  given  any  preference  over  the 
rest  of  the  children  of  men  and  many  of  them  stand  under  the  ban 
of  that  combination  of  prudery  and  lust  which  governs  the  atti- 
tude of  most  cultivated  people  in  sexual  matters.  Even  those 
whose  medical  experience  will  not  allow  them  to  escape  from  the 

^  This  applies  especially  to  the  Swiss  school  with  Bleuler  and  Jung 
at  its  head.  Compare  the  important  works  of  this  school  in  the  bibli- 
ography of  the  Jahrhuch  fur  psychoanalytische  und  psychopathologische 
Forschungen,  published  under  the  supervision  of  Bleuler  and  Freud  and 
edited  by  Jung,  Vol.  II,  1910. 


INTRODUCTION  3 

observation  that  sexuality  plays  an  important  role  in  the  neuroses 
deny  the  universal  application  of  this  experience  and  dispute  the 
conclusion  that  in  every  case  the  exciting  or  decisive  causes  must 
be  of  a  sexual  nature.  Against  this  attitude  is  Freud's  assertion 
that  his  experience  of  many  years  has  as  yet  shown  no  exception 
to  this  rule.  It  will  thus  be  necessary  to  wait  and  see  if  in  the 
use  of  the  method  of  investigation  developed  by  Freud  any  excep- 
tions may  be  proven.^ 

In  strange  contrast  to  this  reproach  of  unjustified  generaliza- 
tions is  brought  forward  from  another  side  the  assertion  that 
Freud's  teaching  brings  forth  absolutely  nothing  new,  but  merely 
reiterates  the  old  naive  folk-opinion  which  brought  the  affections 
into  close  connection  with  nervous  and  mental  diseases.  While 
Freud  has  acknowledged  with  satisfaction  these  supporters  who 
are  in  no  way  to  be  despised,  still  it  must  be  kept  clearly  in  mind 
what  a  distance  separates  his  exact  scientific  methods  and  demon- 
strations from  these  primitive  and  naive  folk-beliefs.  This  applies 
especially  to  the  question  of  whether  or  not  dreams  can  be  inter- 
preted; that  dreams  are  susceptible  of  a  genuine  scientific  inves- 
tigation the  scholastics  deny ;  against  this  learned  opinion,  Freud's 
splendid  work  has  produced  the  proof  that  dreams  have  a  real 
meaning  in  the  sense  of  the  primitive  folk-belief.  Whoever  con- 
descends to  interpret  his  own  or  another's  dreams  according  to 
the  Freudian  principles  will  soon  bow  respectfully  before  this, 
perhaps  the  most  important  of  Freud's  contributions,  and  arrive 
at  identical  results.^  On  the  other  hand,  the  common  sentiment 
of  all  people  in  favor  of  free-will  in  mental  processes  is  in  direct 
opposition  to  the  recognition  by  the  Freudian  theory  of  a  strict  de- 
terminism of  every  psychic  process ;  likewise,  the  ignorance  of  sym- 
bolism which  is  indispensable  for  dream  and  symptom  interpreta- 
tion creates  a  doubt  of  its  reality  and  justification.*  Finally,  much 
opposition  has  been  manifested  against  the  numerous  observations 
which  Freud  has  reported  concerning  the  early  sexual  expressions 

'One  may  compare  with  this  the  course  of  development  of  the  etio- 
logical views  regarding  tabes  dorsalis  where  now  syphilis  is  considered 
an  invariable  antecedent. 

'Compare  for  example  Eberhard  Buchner.  "Traum  und  Traumde- 
tung,"  in  Frankfurter  Zeitung  of  Jan.  30,  1910. 

*Both  of  these  objections  which  arise  from  the  nature  of  things  will 
be  made  intelligible  and  refuted  in  the  course  of  the  presentation. 


4  freud's  theory  of  the  neuroses 

of  children  which  until  now  were  quoted  by  others  merely  as  odd 
or  as  frightful  examples  of  precocious  depravity.  Here  again 
anyone  who  has  made  similar  observations  can  be  convinced  of 
the  universality  of  these  occurrences ;  indeed  one  should  not  spare 
himself  the  trouble  of  directing  his  attention  to  such  unpleas- 
ant signs. 

A  part  of  the  antagonism  is  explained  by  the  fact  that  Freud 
is  compelled  by  his  investigations  to  use  the  word  sexuality  in  a 
broader  sense  than  usual,  giving  it  about  the  same  meaning  as  the 
word  "  love  "  in  the  German  language,  thus  asserting  the  under- 
lying unity  of  all  love  from  the  grossly  sensual  sexual  intercourse 
to  the  most  unassuming  exhibition  of  affection.  The  use  of  the 
term  sexuality  in  the  Freudian  sense  is  justified  psychologically 
and  brings  forward  a  most  fruitful  point  of  view.  It  is  also 
obvious  that  not  only  the  actual  activities  of  the  sexual  life  but 
also  its  phantasies  are  to  be  considered.  Freud  refuses  to  counte- 
nance the  narrow  and  degraded  use  of  the  word  sexuality  on 
which  a  part  of  the  antagonism  rests. 

A  condition  which  has  hitherto  really  hindered  to  a  certain 
degree  the  diffusion  and  confirmation  of  Freud's  views  regarding 
the  neuroses  is  the  fact  that  so  far  there  is  no  systematic  and 
complete  exposition  of  the  method  of  the  analysis;  in  medicine, 
one  is  usually  accustomed  to  acquire  the  method  and  thus  be  in  a 
position  to  test  it  at  first  hand.  Further,  a  practical  demonstra- 
tion of  the  method,  a  public  psycho-analysis  as  it  were,  is  impos- 
sible. Of  course,  it  is  always  possible  for  those  really  interested 
to  acquire  the  technique  by  personal  contact  with  Freud  and  by 
their  own  subsequent  exertions  which  as  a  matter  of  fact  many 
have  succeeded  in  doing.  On  the  other  hand,  the  technical  diffi- 
culties in  the  way  of  reproducing  the  analyses  render  learning 
from  examples  a  hard  task.  Freud's  relatively  few  published 
analyses"  are  only  put  forth  in  fragmentary  form  because  their 
complete  reproduction  would  take  an  enormous  space  and  bring 
the  physician  into  conflict  with  his  duty  of  discretion.  On  the 
other  hand,  individual  details  torn  from  their  context  lose  the 

"Freud,  "Bruchstiick  einer  Hysterieanalyse "  (Literature  index  No. 
2i),  "Analyse  der  Phobie  eines  fiinfjahrigen  Knaben"  (Jahrb.  I),  "  Be- 
merkungen  uber  einen  Fall  von  Zwangsneurose "  (ebenda).  Further, 
compare  L.  Binswanger,  "  Versuch  einer  Hysterieanalyse"  (ebenda)  as 
well  as  other  articles  in  the  Jahrbuch  with  brief  analyses. 


INTRODUCTION  5 

greatest  part  of  their  power  to  convince.  For  these  reasons,  the 
present  exposition  cannot  cite  case  records.  For  the  rest,  one 
could  not  by  innumerable  examples  or  brochures  convince  those 
who  will  not  allow  themselves  to  be  convinced,  while  those  who 
have  already  gained  a  conviction  of  the  objective  reality  of  the 
unconscious  pathogenic  material  already  possess  in  their  own 
experience  the  means  of  confirming  the  progress  in  the  realm  of 
the  Freudian  theory  of  the  neuroses.  They  will  also  be  in  the  best 
position  to  oppose  those  all  too  numerous  individuals  who  will 
always  repeat  the  assertion  that  much  of  the  pathogenic  sexual 
material  which  the  analysis  uncovers  in  the  patients  examined  has 
been  suggested  to  them.  He  who  has  listened  to  such  a  patient 
calmly  and  without  prejudice  for  hours  at  a  time  will  be  easily 
convinced  that  every  neurotic  is  full  of  the  subject  and  is  only 
waiting  to  confide  to  an  appreciative  listener  the  secrets  carefully 
guarded  from  others,  even  from  those  nearest  him.  Only  by  the 
way  of  psycho-analysis  can  the  therapeutic  results  be  attained 
which  are  in  no  way  connected  with  the  personality  and  authority 
of  an  individual  as  many  sceptically  assert,  but  lie  in  the  correct 
conception  and  utilization  of  the  method  and  its  technique. 

.  In  the  attempt  to  justify  by  plausible  objections  the  untenable 
antipathy  against  this  new-fashioned  and  in  no  way  easily  acquired 
system,  the  reproach  has  been  raised  against  Freud's  conclusions 
that  they  are  not  trustworthy  because  in  the  course  of  years  they 
have  undergone  more  than  one  modification.  It  is  really  scarcely 
necessary  to  defend  against  this  reproach  an  investigator  who  has 
carried  through  so  revolutionary  a  life  work,  many  years  without 
aid  or  encouragement  from  his  colleagues.  Freud  himself  has 
dismissed  it  with  these  words :  "  Whoever  believes  in  the  develop- 
ment of  human  intelligence  will  hear  without  surprise  that  I  have 
learned  to  discard  a  part  of  the  opinions  once  put  forth,  to  modify 
another  part.  Still,  I  have  been  able  to  hold  the  greatest  part 
unchanged  and  need  retract  absolutely  nothing  as  entirely  wrong 
and  quite  worthless."  For  the  intelligent,  the  gradual  evolution 
of  the  Freudian  doctrines  is  rather  the  proof  of  a  remarkable  con- 
ception in  the  beginning,  which  remains  essentially  unchanged  and 
only  undergoes  a  more  detailed  elaboration  in  certain  parts.  This 
progressive  development  gives  the  best  assurance  for  the  belief 
that  this  theory  is  nothing  else  than  the  accumulation  of  continued 


6  FREUD  S  THEORY  OF  THE   NEUROSES 

and  deepening  experience.  It  should  in  no  way  be  denied  that  there 
are  still  to-day  many  points  in  the  Freudian  field  of  work  in  part 
unexplained,  in  part  not  sufficiently  verified  and  that  it  will  require 
not  less  than  a  generation  of  strenuous  labor  to  carry  the  system 
to  its  full  completion.  It  may  be  foreseen  that  the  contents  of 
the  Freudian  philosophy  will  then  be  an  indispensable  part  of 
medical  education  and  that  the  science  of  psycho-analysis  in  the 
hands  of  the  next  generation  of  physicians  will  succeed  to  an 
indispensable  practical  importance. 


CHAPTER   I 

GENERAL   THEORY   OF   THE   NEUROSES 

Freud's  Field  of  Work.  General  Pathology.  Classification  of  the 
Neuroses.  Course  of  Development  of  Freud's  Theory  of  the  Neuroses. 
General  Etiology.  Role  of  Sexuality  and  of  Heredity.  The  Psycho- 
sexual  Constitution.  The  Cultural  Sexual  Morality.  Reference  to  the 
Therapy. 

The  field  of  Freud's  work  comprises  the  neuroses  in  the  nar- 
rower sense  as  well  as  certain  closely  related  psychoses,  such  as 
paranoia,  acute  hallucinatory  confusion,  etc.  Formerly,  numerous 
clinical  pictures  were  included  in  the  term  neuroses  from  which 
many  have  been  separated  by  the  progress  of  the  study  of  the 
blood-forming  organs,  for  example,  Basedow's  disease  and 
tetany,  while  on  the  other  hand,  others  have  been  classified  as 
infections,  for  example,  chorea.  Thus,  the  term  neuroses  has 
now  been  limited  to  neurasthenia,  hysteria  and  the  compulsion  or 
obsessional  neurosis  (Zwangsneurose).  According  to  Freud's 
opinion,  the  neuroses  deserve  the  name  sexual-neuroses,  since  for 
these  clinical  pictures  the  chief  etiological  factors  may  be  proven 
to  lie  in  the  psychosexual  sphere.  In  the  field  of  neurasthenia, 
the  Freudian  investigation  has  yielded  a  classification  of  great 
theoretical  importance  and  practical  significance.  In  a  classical 
study,®  Freud  has  separated  from  the  vague  term  neurasthenia 
the  "anxiety-neurosis"  and  further  sharply  marked  off  a  symptom- 
complex  as  real  or  true  neurasthenia.  He  calls  these  two  clinical 
pictures  true  neuroses  because  their  cause  lies  in  the  present 
abnormal  condition  of  the  sexual  function  of  the  individual  and 
in  opposition  to  these  he  calls  hysteria  and  the  obsessional  neurosis, 
psychoneuroses.'^  In  these  latter,  the  real  causative  factors  in 
contrast  to  those  of  the  true  neuroses  belong  not  to  the  actual 
sexual  life  but  to  a  long  past  period  of  life  in  early  childhood. 

'"t)ber  die  Berechtigung,  von  der  Neurasthenie  einen  bestimmten 
Symptomenkomplex  als  *  Angstneurose '  abzutrennen,"  Lit.  No.  4. 

^  In  the  following  presentation,  neurasthenia  and  hysteria  will  be  used 
as  the  best  known  examples  of  their  kind. 

7 


8  freud's  theory  of  the  neuroses 

Further,  these  infantile  experiences  and  impressions  which  only 
later  become  actively  pathogenic  turn  out  to  belong  without  excep- 
tion to  the  erotic  life  which  is  generally  though  erroneously 
believed  to  be  completely  negligible  in  the  child.  Thus  in  every 
case  of  neurosis,  a  sexual  etiology  was  revealed ;  in  neurasthenia, 
the  agencies  were  of  a  physical  nature,  in  the  psychoneuroses,  of 
an  infantile  nature.  A  second  essential  difference  between  these 
two  groups  of  nervous  maladies  is  to  be  sought  in  the  fact  that  in 
the  true  neuroses  the  disturbances  (symptoms)  may  find  expres- 
sion in  physical  or  mental  manifestations  which  seem  to  be  of  a 
toxic  nature ;  they  are  similar  to  the  phenomena  accompanying  an 
excess  or  deficiency  of  certain  nerve  poisons.  These  neuroses, 
formerly  grouped  mostly  under  neurasthenia,  can  be  produced  by 
certain  injurious  influences  of  the  sexual  life  without  any  neces- 
sary hereditary  predisposition;  indeed  the  form  of  the  malady 
corresponds  to  the  kind  of  injurious  influence  so  that  frequently 
one  can  infer  the  special  sexual  etiology  merely  from  the  clinical 
picture  presented.  With  the  psychoneuroses  on  the  other  hand, 
the  influence  of  heredity  is  more  important,  the  original  cause  less 
evident.  A  special  method  of  investigation  which  will  be  described 
later  as  psycho-analysis  has,  however,  allowed  the  fact  to  be  recog- 
nized that  the  symptoms  of  the  disorders  (hysteria,  obsessional 
neurosis,  etc.)  are  psychogenic,  depending  on  the  activity  of  uncon- 
scious (repressed)  idea-complexes.  This  same  method  has  also 
recognized  these  complexes  and  shown  them  to  be  universally  of 
a  sexual  erotic  content ;  they  arise  from  the  sexual  needs  of  indi- 
viduals ungratified  in  the  broadest  sense  of  the  word  and  afford 
them  a  kind  of  substitute  gratification. 

^JDie  yalue_of  the  theoretical^ distinctk>n  between  the  toxic 
(true)  neuroses  and  the  psychogenic  neuroses  h  not  diminished 
by  the  fact  that  in  most  nervous  persons  disturbances  due  to  both 
sources  may  be  observed.  Such  mixed  cases  are  very  frequent ; 
thus,  the  obsessional  neurosis  is  often  associated  with  neuras- 
thenia, anxiety-neurosis  with  hysteria  (compare  later  "anxiety- 
hysteria").  In  all  these  cases,  a  mixed  and  combined  etiology  in 
the  sense  explained  later  is  found  without  exception. 

While  it  was  just  now  stated  that  those  two  great  groups  of 
diseases  were  the  original  field  of  Freud's  work,  it  must  be  empha- 
sized that  for  about  fifteen  years  Freud  has  not  had  opportunity 


GENERAL   THEORY    OF    THE    NEUROSES  9 

to  continue  his  investigation  of  the  true  neuroses,  hence  this  part 
of  the  theory  has  not  experienced  a  further  expansion.  The  im- 
portant progress  which  the  comprehension  of  the  nature  of  the 
psychoneurotic  troubles  has  made  in  the  meantime  will  place  their 
relation  to  the  true  neuroses  in  a  somewhat  different  light  and  it 
will  probably  necessitate  a  revision  in  this  field  in  the  near  future. 
The  more  limited  field  of  Freud's  work  is  constituted  by  the 
psychoneurotic  forms,  especially  hysteria  and  the  obsessional 
neurosis,  and  it  is  exceedingly  instructive  to  follow  the  steps  in  the 
development  of  the  nucleus  of  the  Freudian  doctrine  if  one  wishes 
to  appreciate  the  full  extent  and  value  of  his  theory  of  the  etiolog- 
ical significance  of  the  psychosexual  agencies  for  the  neuroses. 

As  a  pupil  of  Charcot  in  Paris  in  1885-1886,  Freud  received 
important  incentives  to  investigation.^  Prominent  among  these 
was  the  step  by  which  Charcot  surpassed  the  level  of  his  original 
conception  of  hysteria  and  assured  himself  the  fame  of  being  the 
first  to  explain  this  enigmatical  malady,  a  fact  of  great  significance 
for  the  further  investigations  in  this  field.  While  Charcot  was 
engaged  in  the  study  of  the  hysterical  paralyses  which  follow 
dreams  the  idea  came  to  him  to  reproduce  these  paralyses  artifi- 
cially and  to  this  end  he  made  use  of  hysterical  patients  whom  he 
brought  into  the  somnambulistic  state  by  hypnosis.  He  succeeded 
in  proving  that  these  paralyses  may  be  the  result  of  ideas  which 
have  gained  the  mastery  of  the  patient's  brain  in  moments  of 
special  disposition.  Thus  was  the  mechanism  of  an  hysterical 
symptom  elucidated  for  the  first  time  and  this  incomparably  beauti- 
ful piece  of  clinical  investigation  enabled  Charcot's  pupil,  P.  Janet, 
to  pave  the  way  for  a  deeper  penetration  into  the  peculiar  psychic 
processes  of  hysteria.  This  example  was  followed  by  Breuer  and 
Freud  who  succeeded  in  sketching  a  psychological  theory  of 
hysteria  in  their  jointly  published  "  Studies  in  Hysteria"  ( 1895) .  In 
the  years  1880-1882,  Breuer  had  observed  a  noteworthy  case  of  hys- 

'  Compare  Freud's  obituary  notice  on  Charcot,  Lit.  No.  23.  While 
lecturer  in  Vienna  University,  Freud  translated  into  German  the  most 
important  works  of  his  French  master,  J.  M.  Charcot,  "  Poliklinische 
Vortrage,"  School-year  1887-88.  "  Neue  Vorlesungen  iiber  die  Krank- 
heiten  des  Nervensystems,  indesondere  iiber  Hysterie."  H.  Bernheim, 
"  Die  Suggestion  und  ihre  Heilwirkung."  "  Neue  Studien  uber  Hypno- 
tismus,  Suggestion,  und  Psychotherapie."  Collected  by  the  press  of  F. 
Deuticke,  Vienna  and  Leipzic. 


lO  FREUD  S   THEORY  OF  THE   NEUROSES 

teria  which,  in  so-called  hypnoidal  states,  revealed  to  the  attending 
physician  those  psychic-traumatic  experiences  which  had  brought 
about  the  individual  hysterical  symptom.  Thereby  appeared  the 
entirely  new  and  surprising  fact  that  the  individual  hysterical 
symptoms  disappear  when  the  memory  of  the  event  which  caused 
them  is  successfully  brought  to  clear  consciousness,  at  the  same 
time  arousing  its  accompanying  affect  and  having  the  patient 
describe  the  event  in  all  possible  detail  and  give  the  affect  expres- 
sion in  words.  Following  this  classical  observation  of  Breuer's, 
as  you  might  say  the  first  psycho-analysis,  Freud  applied  the 
cathartic  method  to  a  series  of  cases  with  success.  Breuer  and 
Freud  arrived  at  conclusions  which  permitted  of  bridging  the  gap 
between  the  traumatic  hysteria  of  Charcot  and  the  general  non- 
traumatic variety.  Their  conception  was  that  the  hysterical 
symptoms  are  the  continued  activities  of  mental  traumas,  the 
accompanying  affects  of  which  have  been  separated  by  special 
conditions  from  the  conscious  mental  processes  and  are  accord- 
ingly in  a  position  to  attain  an  abnormal  path  to  bodily  innervation 
(conversion).  The  terms  "pent-up  affect,"  "conversion,"  "to 
abreact "  sum  up  the  characteristics  of  this  view.  It  showed  these 
painful  ex|>eriences  "  repressed  into  the  unconscious,"  the  affects 
of  the  original  idea  not  abreacted  as  "  pent-up  " ;  only  by  the  com- 
plete expression  of  this  idea  in  words  could  the  pathogenic  activity 
of  the  old  memory  be  broken.  If  the  requisite  conditions  for 
conversion  are  not  at  hand  in  a  person,  then  the  idea  separated 
from  its  affect  may  remain  separated  from  all  associations  in  con- 
sciousness; the  emotion  thus  set  free  may  become  attached  to 
other  not  unbearable  ideas  and  these  from  this  false  association 
become  obsessions  in  the  broader  sense  of  the  term  (substitution). 
Hysteria  and  obsessional  neurosis  are  thus  both  to  be  considered 
as  cases  of  unsuccessful  defence. 

In  the  further  investigation  of  the  psychoneuroses  to  which 
Freud  now  devoted  himself  exclusively,  he  found  upon  a  more 
detailed  study  of  the  causative  psychic  traumas  from  which  the 
hysterical  symptoms  were  supposed  to  be  derived  that  these  orig- 
inal scenes  which  had  appeared  to  possess  etiological  importance 
must  sometimes  be  absolved  from  being  the  determining  factor 
and  the  traumatic  force  which  occasioned  the  disease.  The  "  trau- 
matic experience"  thus  lost  its  supreme  importance  and  Freud 


GENERAL   THEORY    OF   THE    NEUROSES  II 

found  through  continued  analytic  work  in  the  associated  memories 
of  the  patient  that  no  symptom  of  an  hysteric  could  arise  solely 
from  an  actual  experience,  but  that  in  every  case  a  memory 
awakened  by  association  of  an  earlier  traumatic  experience  usually 
belonging  to  the  time  of  puberty,  which  had  not  at  that  time  caused 
trouble,  cooperated  in  the  causation  of  the  symptom.  A  further 
result  of  this  later  analytic  work  was  the  discovery  that  from 
whatever  case  or  whatever  symptom  one  wished  to  start,  he  finally 
came  without  exception  to  the  field  of  sexual  experience.  Here- 
with was  revealed  for  the  first  time  an  etiological  condition  of  an 
hysterical  symptom. 

But  experiences  recovered  with  so  much  trouble,  extracted 
from  the  mass  of  old  memories,  seemingly  the  final  traumatic 
events,  although  they  had  the  two  characteristics  of  sexuality  and 
puberty  in  common,  proved  themselves  to  be  very  disparate  and 
of  different  value  so  that  further  investigation  was  demanded.  It 
was  finally  revealed  that  behind  these  sexual  erotic  events  of 
puberty  are  still  more  far-reaching  experiences  of  infantile  life, 
which  are  also  of  sexual  content  but  of  far  more  uniform  kind 
than  the  previously  revealed  scenes  occurring  at  puberty.  These 
infantile  experiences  evince  their  effect  in  only  the  slightest  degree 
at  the  time  when  they  happen;  far  more  important  is  the  later 
effect,  which  finds  expression  only  in  later  periods  of  maturity. 
Since  these  infantile  experiences  of  sexual  content  can  produce 
a  psychic  effect  only  by  the  aid  of  the  memory,  here  is  revealed 
the  insight  that  hysterical  symptoms  never  arise  without  the 
cooperation  of  the  memory.  Hysterical  patients  suffer  from 
"  reminiscences."  At  the  bottom  of  every  case  of  hysteria  are 
found  one  or  more  events  of  premature  sexual  experience  which 
belong  to  earliest  youth ;  these  may  be  reproduced  in  memory  by 
persevering  analytic  work  even  after  decades  have  intervened. 
At  that  time,  these  traumatic  experiences  were  erroneously  limited 
to  neurotics ;  it  soon  became  evident,  however,  that  such  experi- 
ences were  often  consciously  remembered  by  individuals  who  re- 
mained perfectly  healthy  afterwards,  hence  the  specific  etiological 
agent  in  the  causation  of  the  neurotic  symptoms  could  not  lie  in 
this  circumstance. 

By  a  penetrating  investigation  of  the  sexual  life  of  the  first 
years  of  childhood  this  noteworthy  and  very  instructive  error  was 


12  freud's  theory  of  the  neuroses 

exposed  and  by  a  deepened  insight  into  the  constitutional  factors, 
overcome.  Freud  had  previously  revealed  in  the  "  Drei  Abhand- 
lungen  zur  Sexualtheorie "®  the  whole  polymorphous  fulness  of 
the  normal  infantile  sexual  life  with  its  germs  of  disease  and 
abnormality.  Thereby  infantilism  of  sexuality  took  the  place  of 
the  originally  over-rated  infantile  sexual  traumas.  And  as  the 
sexual  experiences  of  childhood  reported  by  patients  turned  out 
repeatedly  to  be  the  products  of  later- formed  phantasies  from  the 
eroticism  of  puberty  concerning  earlier  childhood,  the  importance 
of  the  preponderating  erotic  phantasy-life  for  the  breaking;  out  oT 
a  neurosis  came  to  the  foreground.  When  Freud  had  finally  suc- 
"ceeded  in  analyzing  a  child-neurosis  in  state  of  formation  there 
was  revealed  the  decisive  influence  of  the  family  constellation  on 
the  content  and  intensity  of  the  child's  affections  as  well  as  for 
the  later  possibilities  of  development.  The  nature  and  degree  of 
the  psychic  fixation  of  the  growing  child  on  the  parents  and 
brothers  and  sisters,  as  well  as  on  the  related  problems  of  birth 
and  procreation,  disclose  themselves  more  and  more  clearly  as  the 
essential  nuclear  complex  of  the  neuroses.  To  the  formation  of 
a  neurosis  from  this  nuclear  complex,  which  is  also  present  in 
normal  individuals,  belong  in  exquisite  fashion,  besides  quantitative 
transgressions,  a  hereditary  predisposition  which  Freud  has  de- 
scribed in  a  narrower  sense  as  the  psychosexual  constitution.  In 
this  decisive  importance  of  the  instinctive  life  and  its  psycho- 
sexually  conditioned  disharmonies  there  has  been  attained  a  pro- 
visional ultimate  source  for  the  later  formation  of  the  neurosis. 

When  Freud  appeared  on  the  scene,  heredity  constituted  the 
most  important  presupposition  of  the  neurosis.  He  could  thus 
with  justice  apply  himself  at  first  to  the  exciting  agencies;  in  this 
connection,  he  has  not  overlooked  but  repeatedly  called  attention 
to  the  fact  that  besides  the  agencies  in  the  psychosexual  field, 
the  etiology  of  the  neuroses  may  be  conditioned  both  by  inherit- 
ance and  by  a  special  constitution  and  that  the  neuroses,  like  all 
other  diseases,  have  complex  causes.  Though  more  recently  the 
theory  of  an  hereditary  predisposition  has  undergone  a  certain 
abridgment,  still  there  is  no  doubt  that  there  are  neuropathic 

•Translation  by  Brill  in  Monograph  Series  of  Journal  of  Nervous 
and  Mental  Disease. 


GENERAL   THEORY   OF   THE    NEUROSES  1 3 

families  in  which  an  hereditary  taint  can  be  clearly  traced.^" 
Freud  thus  assumes  that  the  heredity  finds  expression  in  a  pecu- 
liar psychosexual  constitution  of  the  individual  which  asserts 
itself  in  an  abnormally  strong  and  many-sided  instinctive  life  and 
a  consequent  sexual  precocity.  This  renders  difficult  the  later 
desirable  subjection  of  the  sexual  instinct  to  the  higher  mental 
powers,  its  adaptation  to  the  prevailing  cultural  demands  and 
strengthens  the  obsessional  character  which  the  psychic  repre- 
sensation  of  this  instinct  lays  claim  to.  This  early  and  excessive 
development  of  the  sexual  instinct  brought  about  by  constitutional 
conditions  can  only  be  counteracted  by  an  abnormal  amount  of 
efferent  repressive  effort  (sexual  repression)  ;  the  psychological 
analysis  shows  further  how  to  solve  the  contradictory  mysterious- 
ness  of  hysteria  by  the  perception  of  two  opposing  forces,  a  too 
severe  sexual  abstinence  and  an  excessive  sexual  need.  The  occa- 
sion for  the  onset  of  the  disease  in  the  hysterically  disposed 
person  arises  when,  on  account  of  the  progressive  internal  matur- 
ing process  or  of  external  events,  the  real  sexual  demands  earnestly 
assert  themselves.  Between  the  compulsion  of  the  instinct  and 
the  opposing  force  of  sexual  denial,  the  way  is  prepared  for  the 
malady,  which  does  not  solve  the  conflict  but  seeks  to  escape  it 
by  changing  the  libidinous  strivings  into  symptoms.  The  mani- 
fold varieties  and  the  different  possibilities  of  development  of 
such  an  abnormal  psychosexual  constitution  Freud  has  explained 
in  detail  in  his  "  Drei  Abhandlungen  zur  Sexualtheorie."  Added 
to  the  hereditary  and  constitutional  prerequisite  conditions  of  the 
neurosis,  there  are  many  premature  sexual  experiences  and  activi- 
ties which  act  as  agencies  favoring  its  outbreak;  the  importance 
of  these  could  have  been  so  long  overlooked  only  because  so  much 
more  attention  has  been  directed  to  that  long  past  period  of  the 
lifetimes  of  the  ancestors,  namely  heredity,  than  to  that  long  past 
period  in  the  history  of  the  individual,  namely,  early  childhood. 
Freud  has  done  a  great  service  in  calling  attention  to  the  early 
seduction  of  children  by  other  children  or  adults  and  the  abnormal 

"  Freud  has  emphatically  pointed  out  more  than  once  that  in  more 
than  half  of  his  cases  of  severe  hysteria,  obsessional  neurosis  etc.,  treated 
by  psychotherapy,  syphilis  in  the  father  before  marriage  was  to  be  proven. 
Not  that  the  later  neurotic  children  bore  physical  signs  of  hereditary 
lues  but  that  in  these  cases  the  abnormal  psycho-sexual  constitution  could 
be  observed  as  the  last  offshoot  of  luetic  inheritance. 


14  FREUD  S  THEORY   OF   THE   NEUROSES 

reaction  to  these  experiences  as  a  result  of  an  especial  suscepti- 
bility to  these  impressions.  "  The  greatest  effect  will  be  produced 
by  the  neurosis  when  constitution  and  experience  combine  toward 
the  same  end.^^  An  outspoken  constitution  may  be  able  to  escape 
by  the  impressions  of  life,  a  sufficient  shock  in  life  may  bring  about 
the  neurosis  in  an  average  constitution."^^  Besides  the  admitted 
share  of  true  heredity,  Freud  has  revealed  a  pseudo-heredity  in 
the  influence  of  an  environment  of  nervous  people,  namely  the 
nervous  parents,  and  has  shown  that  there  is  a  nearer  way  than 
heredity  for  nervous  parents  to  transmit  their  disturbances  to 
their  children.  "  It  is  one  of  the  surest  signs  of  a  later  neurosis 
when  a  child  shows  itself  insatiable  in  its  demands  for  caresses 
from  the  parents  and,  on  the  other  hand,  it  is  just  the  neuropathic 
parents  who  tend  to  exhibit  unbounded  affection  and  by  their 
fondling  predispose  the  disposition  of  the  child  to  a  neurotic  out- 
break at  the  earliest  possible  moment.""  Thus  upon  more  care- 
ful analysis,  what  appears  to  be  hereditary  transmission  resolves 
itself  into  the  effect  of  powerful  infantile  influences.  From  a 
higher  point  of  view,  it  is  observed  that  our  present-day  cultural 
standard  of  sexual  morality,  which  imposes  so  many  injuries  and 
restrictions  on  a  natural  life,  is  an  important  factor  in  the  causa- 
tion of  nervous  diseases,  especially  the  true  neuroses.  Cultural, 
indeed  still  more  frequently,  material  agencies  often  place  insur- 
mountable obstacles  in  the  way  of  a  normal  sexual  life,  which  is 
necessary  as  a  protection  against  neurasthenic  and  anxiety- 
neurotic  troubles,  for  in  this  connection  it  is  found  that  nothing 
else  is  necessary  for  a  cure  except  the  correction  of  the  inadequate 
sexual  gratification.  Much  more  difficult  is  the  treatment  of  the 
psychoneuroses ;  for  the  healing  of  these  a  very  complicated  psy- 
chological technique  has  been  perfected,  which  will  be  explained 
later ;  in  certain  particulars  this  is  still  undergoing  deepening  and 
refinement. 

"The  admission  that  there  may  be  such  a  combination  of  diflferent 
causes  instead  of  the  assertion  of  one  set  of  causes  is  a  peculiarity  of  the 
Freudian  theory  of  the  neuroses  which  never  fails  to  emphasize  the 
variety  of  causes  and  in  no  way  conducts  itself  in  a  one-sided  dogmatic 
fashion  as  it  is  reproached  with  doing. 

"Lit  No.  20. 


CHAPTER   II 

THE  TRUE   NEUROSES 

A.  Neurasthenia:  Clinical  Picture;  Etiology;  Prophylaxis  and 
Therapy.  B.  Anxiety-Neurosis:  Symptomatology;  Etiology;  Theory.  C. 
Refutation  of  the  Objections  to  the  Sexual  Etiology  of  the  True  Neuroses. 

A.  True  Neurasthenia 

As  already  related,  while  Freud  was  following  the  causative 
sexual  injuries  in  detail,  he  succeeded  in  showing  that  neuras- 
thenia as  it  had  been  described  by  the  earlier  authors  resolved 
itself  into  two  typical  clinical  pictures :  into  so-called  "  true 
neurasthenia"  and  into  anxiety-neurosis,  which  forms  not  only 
have  a  specific  etiology  but  can  also  be  sharply  differentiated  clin- 
ically. Under  neurasthenia,  Freud  understands  those  frequent 
symptom-complexes  of  pressure  in  the  head,  spinal  irritation, 
dyspepsia  with  flatulency  and  constipation,  paresthesias,  dimin- 
ished potency,  as  well  as  a  prevailing  emotional  depression. 
According  to  Freud's  views,  this  clinical  picture  corresponds  to 
the  specific  cause  of  excessive  masturbation  or  frequent  pollutions 
or  better  expressed:  neurasthenia  may  in  every  case  be  traced 
back  to  a  condition  of  the  nervous  system  which  has  been  acquired 
through  excessive  masturbation  or  arisen  spontaneously  from 
frequent  pollutions.^^  This  picture  of  neurasthenia  is  a  fairly 
uniform  one,  hence  the  various  pseudo-neurasthenias  (as  the 
nervous  disturbances  of  cachexia  and  arterio-sclerosis,  the  early 
conditions  of  progressive  paralysis  and  of  many  of  the  psychoses, 
etc.)  may  be  more  sharply  differentiated  from  true  neurasthenia 
than  formerly.  Further,  according  to  Moebius's  proposal  many 
a  status  nervosi  of  hereditary  degenerates  can  be  placed  at  one 
side  and  one  will  also  find  reasons  for  classifying  many  neuroses 
which  are  to-day  called  neurasthenia,  especially  those  of  inter- 
mittent or  periodical  nature,  more  properly  as  melancholia  (cyclo- 
thymia). The  neurasthenia  of  the  authors  really  includes  much 
more,  but  also  much  that  is  ill-defined.    The  place  of  hypochondria 

"Lit  No.  23. 

15 


1 6  freud's  theory  of  the  neuroses 

remains  for  the  present  unexplained,  though  certain  forms  seem 
to  correspond  to  a  third  form  of  true  neurosis. 

To  make  easier  the  comprehension  of  true  neurasthenia,  the 
course  of  development  of  a  typical  case  may  be  briefly  sketched. 
A  boy  who  practices  onanism  excessively"  at  puberty  usually  re- 
mains without  control  until,  warned  by  companions  or  one  of  those 
dangerous  popular  scientific  books,  he  is  changed  into  an  hypo- 
chondriac who  interprets  the  symptoms  of  his  neurasthenia  as  the 
premonitory  signs  of  a  softening  of  the  brain  and  spinal  tubercu- 
losis resulting  from  his  self -pollution.  Falling  into  anxiety  and 
depression,  he  suddenly  gives  up  his  masturbation  and  often 
begins  to  suffer  from  frequent  pollutions.  The  outlet  provided 
for  the  discharge  of  the  sexual  product  by  the  act  of  masturbation 
does  not  correspond  to  the  complicated  spinal  reflex  act  with  its 
psychic  preliminaries  as  provided  by  normal  coitus.  From  this 
abuse  arises  also  the  widespread  symptom  of  ejaculatio  prsecox, 
which  betrays  years  afterward  the  youth  who  had  been  greatly 
given  to  onanism  with  phantasies.^"  Such  men  are  usually  not  in 
condition  to  give  the  woman  the  normal  outlet  for  her  excitement 
and  gratification  of  coitus,  a  condition  which,  as  will  later  be 
explained  in  detail,  leads  to  anxiety-neurosis  in  the  woman.  It 
is  obvious  that  it  is  the  duty  of  the  physician  to  forbid  the  excess- 
ive onanist  his  manner  of  sexual  gratification.  But  it  is  recom- 
mended that  this  be  done  without  dire  predictions  of  the  terrible 
results  of  continuing  this  vice,  in  contrast  to  the  pseudo-scientific 
articles ;  rather  it  should  be  done  by  advising  a  gradual  giving  up 
of  the  practice  and  seeking  to  strengthen  the  patient  by  dietetic 
and  hydrotherapeutic  measures.  If  frequent  pollutions  still  con- 
tinue then  a  strict  avoidance  of  all  incentives  to  sexual  excitement 
seems  indicated  as  well  as  a  regulation  of  the  digestion.  If  the 
patient  is  not  helped  by  these  measures  then  it  becomes  necessary 
to  recommend  a  normal  method  of  gratifying  the  sexual  appetite. 
For  the  sexual  need  once  aroused  and  long  gratified  no  longer 
permits  itself  to  be  silenced,  but  only  transferred  to  another  object. 

"Light  forms  of  neurasthenia  because  of  corresponding  conditions 
may  be  found  in  childhood. 

"The  so-called  "mental  onanism"  (phantasies  leading  to  ejaculation), 
further  the  protracted  masturbation  which  puts  off  the  ejaculation,  finally 
the  "masturbatio  interrupta"  which  prevents  the  ejaculation  seem  to  be 
especially  injurious  (Stekel). 


THE   TRUE    NEUROSES  1 7 

A  therapeutic  interference  of  that  kind  is  also  best  suited  to  con- 
vince the  practical  physician  of  the  correctness  of  the  specific 
etiology  of  neurasthenia  here  described;  for  a  cure  follows  the 
removal  of  the  sexual  injury.  That  the  former  therapeutic  meas- 
ures, such  as  sanitarium  treatment,  travel  and  water  cures,  etc., 
now  and  then  show  results  is  explainable  by  the  fact  that  unin- 
tentionally they  also  change  the  patient's  sexual  relations,  which, 
according  to  recent  investigations,  are  regularly  the  cause  of  such 
apparent  results.  These  improvements  are  therefore  often  only 
transitory  and  especially  unreliable. 

The  chief  service  which  the  wise  physician  can  render  to  the 
neurasthenic  lies  in  the  prophylaxis.  If  excessive  masturbation 
in  youth  is  the  cause  of  neurasthenia,  then  the  prevention  of  the 
same  in  both  sexes  deserves  more  attention  than  it  has  yet  received. 
Until  now,  the  weighty  question  of  masturbation  could,  however, 
receive  no  decisive  answer  because,  on  the  one  hand,  the  existence 
of  masturbation  in  the  suckling  and  child  has  not  been  sufficiently 
recognized  and,  on  the  other  hand,  no  agreement  has  been  reached 
between  the  disparate  medical  views  regarding  the  onanism  of 
puberty  and  later  life.  The  purely  autoerotic  masturbation  in 
the  littlest  children  may  seldom  and  only  in  excessive  cases  demand 
the  interference  of  the  tutor,  not  to  mention  the  physician. 
Childish  onanism  around  the  third  to  fourth  or  fifth  years  must 
within  certain  limits  be  considered  a  normal  phenomenon.^' 
Further,  this  is  normally  soon  replaced  by  the  so-called  latent 
period.  If  this  does  not  occur  or  if  the  practice  becomes  excess- 
ive, then  it  must  be  checked.  Nevertheless,  terrifying  and 
gruff  prohibition  is  to  be  avoided ;  much  more  can  be  accomplished 
by  gentler  methods.  Often  in  the  neurosis  which  breaks  out  later 
there  appears  the  anxious  hallucination  of  parental  prohibitions; 
through  the  quite  customary  threat  of  cutting  off  the  penis,  a 
further  psychic  trauma  may  be  inflicted  which  is  frequently  fol- 
lowed by  lasting  and  pernicious  results. 

Far  more  important  is  the  problem  of  the  onanism  of  puberty 
and  later  life,  over  which  the  most  opposite  experiences  are 

*•  Among  the  patients  suflfering  from  impotence,  are  a  relatively  large 
number  who  have  never  practiced  onanism  at  all,  and  there  seems  to  exist 
a  connection  between  the  neglect  of  the  act  of  masturbation  which  pre- 
supposes a  certain  activity  and  the  sexual  weakness. 


1 8  freud's  theory  of  the  neuroses 

reported  and  the  most  contradictory  views  held.  It  must  be 
emphasized  at  the  beginning  that  this  onanism  can  not  be  entirely 
avoided,  because  in  our  civilized  social  organization  too  great  an 
interval  has  been  interposed  between  the  awakening  of  the  sexual 
instinct  and  the  possibility  of  its  regular  gratification.  There  is 
thus  the  necessity  of  allowing  this  mode  of  gratification  up  to  a 
certain  degree,  that  is  within  moderate  limits  and  with  quieting 
explanations;  it  can  then  be  observed  that  this  happens  without 
real  injury.  The  injuriousness  of  a  precocious  or  later  excessive 
onanism  is  only  in  small  part  conditioned  by  the  very  nature  of 
masturbation.  There  is,  however,  a  special  sexual  constitution 
which  causes  certain  people  to  become  ill  as  a  result  of  masturba- 
tion while  others  bear  their  onanism  of  puberty,  which  is  nothing 
more  than  the  revival  of  the  masturbation  of  earliest  childhood, 
without  noticeable  injury.  In  general,  the  injuriousness  especially 
of  excessive  masturbation  is  not  to  be  doubted  in  the  least,  even 
if  a  part  of  the  medical  profession  is  not  inclined  to  share  the 
hypochondriacal  exaggerations  of  many  nervous  patients  who 
would  trace  back  all  evil  to  their  self -gratification.  The  injurious- 
ness begins  in  the  somatic  field  in  that  onanism  gives  occasion  to 
excessive  sexual  activity,  does  not  take  into  consideration  all  the 
psychological  sources  of  excitement,  affords  inadequate  relief  and 
diminishes  potency.^^  More  important  are  the  injuries  in  the 
mental  field.  These  come  to  light  both  in  the  demands  of  the 
sexual  life  and  also  in  those  of  the  social  life.  For  the  former, 
a  serious  result  is  a  lasting  inability  to  endure  abstinence  or  coitus 
interruptus.  Further,  there  comes  about  a  sort  of  turning  away 
from  reality,  from  the  female  sexual  object,  which  is  later  dis- 
closed in  an  intolerance  of  the  necessary  imperfections  in  the 
same.  As  one  of  the  chief  mental  injuries  of  onanism,  must 
finally  be  asserted  the  fact  that  it  favors  in  every  relation  the 
fixation  of  an  infantile  condition  which  furnishes  the  proper 
foundation  for  the  psychoneurotic  illness.  The  injuries  which 
the  onanist  experiences  for  his  social  life  are  numerous.  The  easy 
attainability  of  the  goal  of  gratification  in  masturbation  weakens 
the  individual — according  to  the  Freudian  principle  of  psycho- 
sexual  parallelism,  that  is  the  typicalness  of  the  sexual  life  for  his 

"  The  stomachache  of  onanists  should  also  be  mentioned.     (Compare 
Lit.  No.  34.) 


THE    TRUE    NEUROSES  I9 

behavior  in  other  relations  of  hfe — for  the  strife  of  Hfe  which 
can  no  longer  be  undertaken  with  the  necessary  display  of  energy. 
Through  his  turning  away  from  society,  the  masturbator  becomes 
antisocial  and  betrays  the  result  of  his  vain  strife  against  passion 
in  a  number  of  other  characteristics,  as  weak  will  power,  doubt 
of  the  possibility  of  accomplishment  and  similar  self-reproaches. 
Thus,  there  seems  to  be  a  kind  of  mental  type  for  him  who  has 
misused  onanism.  From  these  considerations,  the  theory  of 
neurasthenia  should  undergo  a  revision. 

B.   The  Anxiety-Neurosis^* 

Especially  valuable  for  medicine  has  been  Freud's  sharp  differ- 
entiation of  the  symptom-complex  of  the  anxiety-neurosis^^  from 
the  previously  described  clinical  picture  of  true  neurasthenia. 
The  name  anxiety-neurosis  arises  from  the  fact  that  the  various 
components  of  this  symptom-complex  are  grouped  around  the 
cardinal  symptom  of  anxiety  to  which  each  individual  symptom 
shows  a  definite  relationship. 

I.  Clinical  Symptomatology  of  Anxiety-Neurosis. — The  clin- 
ical picture  of  the  anxiety-neurosis  comprises  the  following 
symptoms : 

1.  General  irritability  and  irritation.  A  special  point  of  value 
is  the  expression  of  this  heightened  irritability  through  an  hyperes- 
thesia for  visual  impressions  but  especially  through  an  hyperes- 
thesia for  sounds,  hypersensitiveness  to  noises.  This  is  also  fre- 
quently the  cause  of  sleeplessness,  of  which  more  than  one  form 
belongs  to  the  anxiety-neurosis. 

2.  Anxious  expectation,  a  condition  which  can  be  best  illus- 
trated by  example.  A  lady,  for  example,  who  is  suffering  from 
anxious  expectation,  thinks  of  pneumonia  every  time  her  hus- 
band, who  has  catarrh,  has  an  attack  of  coughing  and  sees  in  her 
mind  his  funeral  passing  by.  If,  on  her  way  home,  she  sees  two 
persons  standing  together  in  front  of  the  door,  she  cannot  help 

"Abbreviated  repetition  of  Freud's  work.  Lit.  No.  4.  Attention 
should  here  be  called  to  the  fact  that  the  English  has  no  exact  equivalent 
for  the  German  word  "  Angst "  which  connotes  apprehension,  dread,  fear, 
etc.,  in  addition  to  anxiety,  which  is  the  nearest  English  word  and  the  one 
which  will  be  used  throughout  this  translation.    Trans. 

"As  a  forerunner  of  the  Freudian  view  may  be  mentioned  the  work 
of  E.  Hecker,  "t)ber  larvierte  und  abortive  Angstzustande  bei  Neuras- 
thenie"  (Zentralblatt  fur  Nervenheilkunde,  Dez.,  1893). 


20  freud's  theory  of  the  neuroses 

thinking  that  one  of  her  children  may  have  fallen  out  of  the 
window;  when  she  hears  the  bell  ring,  someone  is  bringing  bad 
news,  etc.,  while  in  all  these  cases,  there  is  no  especial  occasion 
to  strengthen  such  a  mere  possibility.  For  one  form  of  anxious 
expectation,  that  in  respect  to  the  person's  own  health,  one  can- 
not avoid  the  old  name,  hypochondria. 

A  further  expression  of  anxious  expectation  is  the  frequent 
tendency  to  anxiety  for  certainty  found  in  persons  of  great  moral 
scrupulousness,  which  likewise  varies  from  the  normal  up  to 
skepticism. 

The  anxious  expectation  is  the  nuclear  symptom  of  the  neu- 
rosis ;  in  it  may  plainly  be  seen  a  part  of  the  theory  of  the  same. 
It  can  be  said  that  there  is  here  a  quantity  of  free-floating  fear 
(Angst)  at  hand  which  in  the  expectation  rules  the  choice  of  ideas 
and  is  always  ready  to  attach  itself  to  any  passing  idea. 

3.  The  anxiousness  which  is  constantly  present  can,  however, 
also  break  through  into  consciousness  suddenly,  without  being 
awakened  by  the  course  of  ideas,  thus  causing  an  attack  of  anxiety. 
Such  an  anxiety  attack  may  consist  of  either  an  anxious  feeling 
without  any  associated  idea  or  of  the  idea  of  impending  death,  of 
a  stroke,  of  threatening  insanity,  or  some  paresthesia  may  be 
mixed  with  the  anxious  feeling  (like  the  hysterical  aura),  or 
finally,  with  the  feeling  of  anxiety  may  come  a  disturbance  of  one 
or  more  of  the  bodily  functions,  the  respiration,  circulation,  vaso- 
motor innervation,  glandular  functions,  etc.  Out  of  this  combina- 
tion, the  patient  emphasizes  now  one,  now  another  factor,  he  com- 
plains of  heart  cramp,  dyspnea,  sweating,  ravenous  appetite,  etc., 
and  in  his  representation  the  anxious  feeling  frequently  becomes 
obscured  or  becomes  really  unrecognizable  and  described  as  a 
"  bad  feeling  "  of  indefinite  discomfort. 

4.  There  are  therefore  rudimentary  attacks  of  anxiety  and 
equivalents  of  the  anxiety  attack  of  which  Freud  has  prepared 
the  following  list : 

(a)  Disturbances  of  the  heart's  action,  palpitation  with  brief 
arrh)rthmia,  with  longer  attacks  of  tachycardia  up  to  severe  condi- 
tions of  cardiac  weakness,  the  differentiation  of  which  from 
organic  affections  of  the  heart  is  not  always  easy;  pseudo-angina 
pectoris,^"  a  delicate  diagnostic  field. 

** Compare  M.  Herz,  "Die  sexuelle  psychogene  Herzneurose  (Phreno- 
kardie),"  Braumuller,  Vienna  and  Leipzic,  1909. 


THE    TRUE    NEUROSES  21 

(b)  Disturbances  of  respiration,  many  forms  of  nervous 
dyspnea,^^  asthmatic  attacks,  etc.  These  attacks,  however,  are 
not  always  accompanied  by  recognizable  anxiety. 

(c)  Attacks  of  sweating,  often  nocturnal. 

(d)  Attacks  of  shaking  and  trembling,  which  may  only  too 
easily  be  taken  for  hysterical. 

(e)  Attacks  of  ravenous  appetite  often  accompanied  by 
vertigo. 

(/)  Diarrhea  in  form  of  attacks. 

(g)  Attacks  of  locomotor  vertigo.^^ 

(h)  Attacks  of  so-called  congestions,  about  everything  which 
has  been  called  vasomotor  neurasthenia.  Here  may  be  mentioned 
the  vasomotor  edemas,  the  sudden  dying  of  a  finger,  an  arm  or 
foot  (angina  pectoris  vasomotoria).^' 

(i)  Attacks  of  paresthesias  (these,  however,  seldom  without 
anxiety  or  a  similar  feeling  of  discomfort). 

5.  Nothing  but  a  variety  of  anxiety  attack  are  the  frequent 
night  terrors  (pavor  nocturnus  of  adults),  commonly  accom- 
panied by  anxiety,  dyspnea,  sweating,^*  etc.  This  disturbance 
occasions  a  second  form  of  sleeplessness  in  the  framework  of  the 
anxiety-neurosis.  In  addition,  the  pavor  nocturnus  of  children 
shows  a  form  which  undoubtedly  belongs  to  anxiety-neurosis. 
It  frequently  has  an  hysterical  touch  which  makes  it  appear  as 
something  special  and  brings  it  into  closer  connection  with  the 
anxiety-hysteria  which  will  be  discussed  later. 

6.  A  prominent  place  in  the  symptomatology  of  the  anxiety- 
neurosis  is  occupied  by  vertigo  which,  in  its  lightest  forms,  is 
better  designated  as  giddiness,  in  its  severer  types  as  "attack  of 
vertigo"  with  or  without  anxiety,  which  belongs  to  the  severest 

^Compare  M.  Herz,  "tJber  eine  Form  der  falschen  Dyspnoe  (*  Seuf- 
zerkrampf '),"  Wiener  Klin.  Wochenschrift,  1909,  No.  39.  Both  articles 
of  Herz  give  superfluous  new  names  to  partial  phenomena  of  the  anxiety- 
neurosis. 

*■  The  vertigo  can  become  a  foundation  for  a  locomotor  phobia  such 
as  agoraphobia. 

*  Compare  Curschmann  (Mainz),  "t)ber  Angina  pectoris  vasa- 
motoria,"  III.  Jahresversammlung  d.  Gesellsch.  Deutscher  Nervenarzte, 
Vienna,  1909. 

"Concerning  the  characteristic  dreams,  compare  the  latter  part  of 
chapter  on  hysteria. 


22  FREUD  S  THEORY  OF  THE   NEUROSES 

symptoms  of  the  neurosis.  This  vertigo  never  leads  to  complete 
loss  of  equilibrium.  On  the  other  hand,  it  seems  possible  for 
such  an  attack  of  vertigo  to  be  replaced  by  an  attack  of  profound 
weakness.^'  Other  fatigue  conditions  of  the  anxiety-neurosis 
appear  to  depend  on  a  heart  collapse.  Dizziness  at  heights,  on 
mountains  and  precipices  likewise  frequently  accompanies  anxiety- 
neurosis. 

7.  On  a  basis  of  a  chronic  anxiousness  (anxious  expectation) 
on  the  one  hand,  and  a  tendency  to  attacks  of  vertigo  on  the  other, 
two  groups  of  typical  phobias  develop,  the  first  in  regard  to  gen- 
eral physiological  menaces,  the  other  in  regard  to  locomotion.  To 
the  first  group  belong  the  anxiety  over  snakes,  thunder,  darkness, 
vermin  and  the  like  as  well  as  the  typical  moral  overscrupulous- 
ness.^"  Forms  of  skepticism;  here  the  unattached  anxiety  is 
plainly  applied  to  the  strengthening  of  doubts  which  are  instinc- 
tively implanted  in  every  person. 

The  other  group  embraces  agoraphobia  with  all  its  varieties 
collectively  characterized  by  its  relation  to  locomotion.^^  A  pre- 
ceding attack  of  anxiety  is  here  frequently  the  foundation  of 
the  phobia. 

8.  The  digestion  in  anxiety-neurosis  undergoes  only  a  few  but 
characteristic  disturbances.  Sensations  like  a  tendency  to  nausea 
and  vomiting  are  not  rare  and  the  symptom  of  ravenous  appetite 
either  alone  or  with  other  congestions  can  give  something  of  a 
rudimentary  attack  of  anxiety ;  as  a  chronic  change,  analogous  to 
the  anxious  expectation,  is  found  a  tendency  to  diarrhea  which 
has  given  occasion  for  the  strangest  diagnostic  errors.  The 
diarrhea  is  the  analogue  of  the  frequent  micturition  of  the  anxiety- 
neurosis. 

9.  The  paresthesias  which  may  accompany  the  vertigo  or 
attack  of  anxiety  are  of  interest  because  of  the  fact  that  they  are 
associated  in  a  regular  sequence  like  the  sensations  of  the  hys- 
terical aura.    Nevertheless,  these  associated  feelings,  in  contrast 

"Occasionally  a  sudden  unexpected  feeling  of  fatigue  precedes  it. 
Stekel,  "  Nervose  Angstzustande  und  ihre  Behandlung."  Urban  und 
Schwarzenberg,  Vienna  and  Berlin,  1908. 

**An  intensive  sexual  feeling  of  guilt,  which  can  already  be  cultivated 
by  children,  always  depends  on  the  suppression  of  excessive  libido. 

*  For  this,  the  complete  psychoneurotic  mechanism  is  necessary  (com- 
pare later). 


THE    TRUE    NEUROSES  23 

to  the  hysterical,  are  atypical  and  changeable.  A  large  number 
of  so-called  rheumatic  patients  really  suffer  from  anxiety- 
neurosis.^*  In  addition,  many  cases  of  anxiety-neurosis  show  a 
tendency  to  hallucinations ;  these  cannot  be  considered  hysterical. 

ID.  Many  of  the  so-called  symptoms  which  accompany  or  re- 
place the  anxiety-neurosis  appear  in  chronic  form.  This  applies 
especially  to  the  diarrhea,  vertigo  and  the  paresthesias. 

II.  Occurrence  and  Etiology  of  the  Anxiety-Neurosis. — ^As 
already  explained,  the  morphology  of  this  malady  is  the  corollary 
of  a  typical  etiology  which  makes  it  preferable  to  consider  men 
and  women  separately.  Anxiety-neurosis  occurs  in  females  classi- 
fied according  to  their  age  and  positions  in  life  in  the  following 
cases : 

(a)  As  anxiety  of  virgins  or  adolescents.  A  number  of  indis- 
putable observations  have  shown  that  a  first  experience  with  the 
sexual  problem,  a  rather  sudden  revelation  of  what  up  to  that  time 
had  been  veiled,  for  example  by  the  sight  of  the  sexual  act  or  of 
the  male  genitals,  by  a  lecture,  printed  or  pictorial  representation, 
can  cause  an  anxiety-neurosis  in  a  maturing  girl  which  is  com- 
bined with  hysteria  in  an  almost  typical  manner  f^ 

■  (b)  As  anxiety  of  the  newly  married.  Young  women  who 
have  remained  anesthetic  during  the  first  co-habitations  often 
develop  an  anxiety  neurosis  which  disappears  again  after  the 
anesthesia  has  given  way  to  a  normal  feeling.  Total  anesthesia 
is  not  meant  here,  but  that  of  those  women  who  are  excitable  up 
to  a  certain  degree  but  are  incompletely  gratified ; 

(c)  As  anxiety  of  women  whose  husbands  exhibit  ejaculatio 
praecox  or  a  very  diminished  potency. 

(d)  Anxiety  of  women  whose  husbands  practice  coitus  inter- 
ruptus  or  reservatus.  These  last  two  cases  belong  together,  for 
it  is  easily  proven  from  the  analysis  of  a  great  number  of  cases 
that  the  occurrence  depends  on  whether  or  not  the  woman  is 
gratified  during  coitus.  In  the  latter  case,  the  ground  is  prepared 
for  the  outbreak  of  an  anxiety-neurosis.  On  the  other  hand,  if 
the  husband  can  gratify  the  woman  either  through  a  better  per- 

**  Compare  F.  Pineles,  "  Zur  Klinik  und  Pathogenese  der  sogenannten 
'  Harnsaureschmerzen,' "  Wiener  Klin.  Wochenschr.,  1909,  No.  21. 

"According  to  the  present  status  of  the  theory,  this  is  more  properly 
classed  as  anxiety-hysteria  (Angsthystefie). 


24  FREUD  S  THEORY  OF  THE   NEUROSES 

formance  of  the  act  or  by  preventing  ejaculation  at  the  beginning 
of  the  act,  she  remains  free  from  anxiety-neurosis.  The  con- 
gressus  reservatus  by  means  of  a  condom  exposes  the  woman  to 
no  injury  if  she  is  very  easily  excited  or  the  man  very  potent;  in 
other  cases,  this  kind  of  conception-preventing  intercourse  is  not 
less  injurious  than  the  other  forms ; 

(e)  As  anxiety  of  widows  and  intentional  abstainers,  often  in 
t)rpical  combination  with  obsessions ; 

(/)  As  anxiety  in  the  climacteric,  during  the  last  great  climax 
of  the  sexual  appetite. 

Classes  c,  d,  e  embrace  the  conditions  under  which  the  anxiety- 
neurosis  begins  most  frequently  in  the  female  sex  and  earliest, 
independent  of  hereditary  disposition. 

For  the  conditions  of  the  anxiety-neurosis  in  men,  Freud  has 
formulated  the  following  groups  analogous  to  those  found  in 
women : 

(a)  Anxiety  of  intentional  abstainers,  frequently  combined 
with  symptoms  of  defence  (obsessions,  hysteria). 

{b)  Anxiety  of  men  as  a  result  of  unsatisfied  excitement  (dur- 
ing the  engagement  period),  further  of  persons  who  through  fear 
of  the  results  of  sexual  intercourse  content  themselves  with  fond- 
ling and  looking  at  the  woman.  This  group  of  conditions  (which 
is  also  transferable  unchanged  to  the  other  sex),  engagement, 
relations  with  sexual  forebearance,  afford  the  purest  cases  of  the 
neurosis. 

(c)  Anxiety  of  men  who  practice  coitus  interruptus,  therewith 
delaying  the  ejaculation  until  the  woman  is  gratified.  This  form 
of  anxiety-neurosis  in  men  is  usually  mixed  with  neurasthenia. 

{d)  Anxiety  of  men  in  the  senium.  There  are  men  who 
show*"  a  climacteric  like  that  of  women  and  at  the  time  of  their 
diminishing  potency  and  increasing  libido,  develop  anxiety- 
neurosis. 

For  both  sexes,  the  two  following  classes  apply: 

{e)  Neurasthenics  as  a  result  of  masturbation  fall  into 
anxiety-neurosis  as  soon  as  they  forego  their  method  of  sexual 
gratification.  These  persons  have  rendered  themselves  especially 
unable  to  stand  abstinence. 

It  is  here  important  for  the  understanding  of  the  anxiety- 

"  Compare  F,  Pineles,  /.  c. 


THE   TRUE    NEUROSES  2$ 

neurosis  to  notice  that  a  very  serious  case  of  this  condition  occurs 
only  in  men  who  remain  potent  and  in  women  not  entirely 
anesthetic. 

(/)  Anxiety-neurosis  arises  in  both  sexes  occasionally  from 
overwork,  exhausting  exertion,  for  example,  night  watching, 
nursing  the  sick  and  after  severe  illness.^^ 

In  addition  to  the  results  of  his  observations,  Freud  has  sought 
to  give  a  theoretical  interpretation  of  the  pathogenesis  of  anxiety- 
neurosis  in  which  he  takes  into  account  the  observation  that  many 
cases  of  anxiety-neurosis  accompany  an  appreciable  lessening  of 
the  libido  or  psychic  pleasure. 

In  the  points  adduced  thus  far  concerning  the  anxiety-neurosis 
there  are  sufficient  stopping  points  from  which  to  gain  a  view  of 
the  mechanism  of  this  neurosis.  One  gains  the  impression  that  it 
has  to  do  with  an  accumulation  of  excitement;  that  the  anxiety 
which  corresponds  to  this  accumulated  excitement  as  psychic 
anxiety  which  finds  no  outlet  is  of  somatic  origin ;  and  further  that 
the  accumulated  excitement  is  of  a  sexual  nature.  These  hints 
favor  the  expectation  that  the  mechanism  of  the  anxiety-neurosis 
is  to  be  sought  in  the  diversion  of  the  somatic  sexual  excitement 
from  the  psychic  and  in  the  abnormal  application  of  this  diverted 
excitement  caused  thereby.  This  idea  of  the  mechanism  of  the 
anxiety-neurosis  can  be  made  clearer  by  a  consideration  of  the 
normal  sexual  process,  at  first  only  as  it  occurs  in  men.  The 
normal  sexual  act  may  be  sketched  as  follows:  First  there  is  an 
accumulation  of  somatic  excitation ;  this  increases  to  a  point  where 
it  occasions  a  psychic  irritation,  creating  the  libido ;  finally  this  is 
discharged  by  a  complicated  spinal  reflex  act  which  must  also 
carry  off  the  psychic  excitement  simultaneously.  Such  a  psychic 
discharge  is  only  possible  by  the  way  which  Freud  has  called  ade- 
quate or  specific  action.  The  etiology  of  true  neurasthenia  and 
anxiety-neurosis  finds  its  place  in  the  outline  of  this  representation 
of  the  sexual  process,  which  in  essentials  is  also  applicable  to  the 
woman.  Neurasthenia  ensues  every  time  the  adequate  discharge 
is  replaced  by  an  inadequate  one,  as  when  normal  coitus  under 
favorable  conditions  is  replaced  by  masturbation  or  spontaneous 

*^  Compare  in  this  connection  the  remarks  on  the  sexual  mechanism  in 
distinction  from  sexual  etiology  (later  in  this  chapter). 


26  freud's  theory  of  the  neuroses 

pollution ;  all  agencies,  however,  which  hinder  the  psychic  utiliza- 
tion of  the  somatic  excitement  conduce  to  anxiety-neurosis. 

The  previously  described  etiological  conditions  of  anxiety- 
neurosis  disclose  the  common  characteristic  of  accumulation  of 
excitement.  Intentional  abstinence  constitutes  the  first  etiological 
factor  for  the  man  in  that  it  prevents  the  specific  action  which 
should  follow  the  libido.  The  somatic  excitement  is  thus  accumu- 
lated and  is  discharged  in  other  ways.  In  this  way,  abstinence 
leads  to  anxiety-neurosis.  Abstinence  is  also  the  real  factor  in 
the  second  etiological  group,  that  of  frustrated  excitement.  The 
third  class,  that  of  coitus  with  precautions  (reservatus),  acts 
injuriously  by  disturbing  the  psychic  preparation  for  the  sexual 
discharge  since  it  interposes  another  diverting  psychic  task  before 
allowing  the  completion  of  the  sexual  act.  Anxiety  in  the  senium 
(climacteric  of  men)  demands  another  explanation.  There  is 
here,  as  in  the  climacteric  of  women,  such  an  increase  in  the 
production  of  somatic  excitement  that  the  mind  proves  relatively 
inefficient  to  care  for  the  same. 

The  etiological  conditions  in  the  woman  may  without  difficulty 
be  viewed  from  the  same  standpoints.  In  addition,  the  disa- 
greement between  the  somatic  and  the  psychic  in  the  course  of  the 
sexual  excitement  can  occur  earlier  in  the  woman  and  is  more 
difficult  to  remove  than  in  the  man. 

Thus,  the  Freudian  view  considers  the  symptoms  of  the 
anxiety-neurosis  as  substitutes  in  a  way  for  the  omitted  specific 
action  which  should  follow  the  sexual  excitement.  As  a  further 
corroboration  of  this  view,  it  should  be  remembered  that  also  in 
normal  coitus  the  excitement  is  accompanied  by  acceleration  of 
the  respiration,  palpitation,  sweating,  congestion,  etc.  In  the  cor- 
responding attack  of  anxiety  of  our  neurosis,  there  is  the  dyspnea, 
palpitation,  etc.,  of  coitus  isolated  and  exaggerated. 

In  those  exceptional  cases  which  do  not  arise  from  specific 
causes  but  from  other  banal  injuries,  such  as  nursing  the  sick, 
overwork,  etc.,  the  sexual  etiology  is  indeed  absent  but  the  illness 
is  established  on  the  foundation  of  a  sexual  mechanism,  since 
general  exhaustion  renders  the  mind  unable  to  care  for  the  somatic 
excitement  which  continually  makes  demands  on  it. 

This  reference  to  the  exceptional  causes  of  the  anxiety-neurosis 
is  always  overlooked  by  the  critics  who,  in  opposition  to  Freud, 


THE   TRUE    NEUROSES  2/ 

think  they  have  found  anxiety-neuroses  without  sexual  injury. 
This  explanation  of  a  sexual  mechanism  replacing  a  sexual  etiol- 
ogy is,  however,  a  very  important  one,  and  it  is  easy  to  make  the 
same  one  for  those  very  similar  cases  of  neurasthenia  not  of 
sexual  etiology,  for  example,  those  occurring  with  arterio-scle- 
rosis.  In  these  conditions,  the  disease  may  also  arise  from  indi- 
rect disturbances  of  the  elaboration  of  sexual  products  like  the 
primary  disturbances  of  other  organic  processes.  By  the  substi- 
tution of  a  sexual  mechanism  for  the  sexual  accidents,  there  may 
result  a  progress  in  the  comprehension  of  the  true  neuroses  similar 
to  that  which  the  theory  of  the  psychoneu roses  experienced  when 
the  importance  of  the  sexual  traumas  was  replaced  by  infantilism 
of  sexuality. 

C.   Refutation  of  the  Objections  brought  against  the 
Sexual  Etiology  of  the  True  Neuroses 

As  already  mentioned,  the  formerly  much  greater  field  of  the 
neuroses  has  been  lessened  by  the  diseases  of  the  blood-forming 
glands.  Neurasthenia  and  anxiety-neurosis  constitute  the  transi- 
tion from  the  sexual  neuroses  to  such  exquisite  toxic  diseases  of 
the  nervous  system.  They  are  caused  by  disturbances  of  sexual 
processes  in  the  organism  which  we  must  call  chemical.  Further, 
they  actually  show  a  great  similarity  to  the  phenomena  of  intoxi- 
cation and  abstinence ;  the  similarity  to  Basedow's  and  Addison's 
diseases  is  obvious. 

Freud,  in  his  assertions  regarding  the  etiology  of  the  true 
neuroses,  knew  that  in  bringing  forward  the  sexual  etiology  he 
adduced  nothing  completely  new,  for  the  undercurrents  in  medical 
literature  which  took  this  fact  into  account  have  never  disappeared. 
Indeed,  in  many  of  these  undercurrents,  the  cure  of  "  sexual  diffi- 
culties "  and  "  nervous  weakness  "  has  been  united  in  a  common 
promise.  Further,  the  official  medicine  of  the  schools  has  really 
noticed  these  relations,  although  it  has  acted  as  if  it  knew  nothing 
of  them.  It  may  easily  be  perceived  that  a  dim  perception  of  the 
predominating  importance  of  sexual  agencies  in  the  production  of 
nervousness  such  as  Freud  has  recently  sought  to  establish  scien- 
tifically has  never  been  absent  from  the  consciousness  of  the  laity, 
as  many  of  the  naive  but  fundamentally  correct  expressions  of 
patients  concerning  the  cause  of  their  troubles  indicate. 


28  freud's  theory  of  the  neuroses 

The  chief  objection  to  Freud's  assertion  of  a  sexual  etiology 
of  the  anxiety-neurosis  concerns  the  fact  that  abnormal  relations 
of  the  sexual  life  are  so  exceedingly  frequent  that  they  must 
always  be  at  hand  whenever  sought.  Thus,  the  existence  of  these 
in  cases  of  anxiety-neurosis  cited  does  not  prove  that  the  etiology 
of  the  neurosis  lies  therein.  Further,  the  number  who  practice 
coitus  interruptus  and  the  like  must  be  incomparably  greater  than 
the  number  afflicted  with  anxiety-neurosis.  In  reply  to  this,  it 
may  be  asserted  that  in  the  recognized  tremendous  frequency  of 
the  neuroses  and  of  anxiety-neurosis  in  particular,  one  ought  not 
to  expect  to  find  a  rare  etiological  agent ;  further,  that  a  postulate 
of  pathology  is  actually  fulfilled  in  this  case,  namely,  that  in  the 
investigation  of  etiology,  the  etiological  agent  must  be  proved 
more  frequent  than  its  result,  since  for  the  latter  other  conditions 
(as  disposition,  total  of  specific  etiologies,  other  banal  injuries) 
may  be  required ;  finally,  that  the  detailed  analysis  of  suitable  cases 
of  anxiety-neurosis  proves  the  significance  of  the  sexual  agency 
beyond  dispute. 

Perhaps  many  a  one  who  is  entirely  ready  to  take  into  account 
the  sexual  etiology  of  the  nervous  malady  will  still  repudiate  it  as 
one-sided  because  he  is  not  requested  to  direct  his  attention  also 
to  the  other  agencies  commonly  mentioned  by  the  authors.  It  is 
far  from  Freud's  intention  to  substitute  the  sexual  etiology  of  the 
neuroses  for  every  other,  hence  he  would  explain  that  the  efficiency 
of  these  remains.  Freud  means  rather  that  in  addition  to  all  the 
known  and  probably  rightly  recognized  etiological  agencies  of  the 
authorities  are  added  the  sexual,  which  have  not  been  sufficiently 
appreciated.  It  should  not  be  forgotten  that  the  etiological  prob- 
lem of  the  neuroses  is  at  least  as  complicated  as  that  of  other 
diseases.  A  single  pathogenic  influence  is  almost  never  sufficient ; 
for  most,  a  combination  of  etiological  agencies  is  necessary,  which 
aid  one  another  and  which  cannot  be  brought  into  opposition  to 
one  another.  The  sexual  agencies  in  the  etiology  of  tiie  neuroses 
deserve,  however,  according  to  Freud's  estimate,  to  be  assigned  a 
prominent  place  in  the  etiological  series.  For  only  these  will  be 
found  missing  in  no  case,  these  alone  are  able  to  produce  the 
neurosis  without  other  assistance,  so  that  the  other  agencies  seem 
reduced  to  the  role  of  predisposing  or  supplementary  causes ;  these 
alone  enable  the  physician  to  recognize  certain  relations  between 


THE   TRUE    NEUROSES  29 

the  variety  and  multitude  of  clinical  pictures.  Heredity,  which  is 
so  strongly  emphasized  by  most  authors,  is  undoubtedly  an  im- 
portant factor  where  it  is  found ;  it  permits  a  severe  case  of  illness 
to  result  where  otherwise  only  a  very  mild  one  would  have  ensued. 
Heredity  alone  is  inaccessible  to  the  physician's  efforts,  while  the 
sexual  causes  are  just  those  which  offer  him  a  good  opportunity 
for  his  therapeutic  activity.  The  agency  of  overwork,  which 
physicians  so  gladly  tell  their  patients  is  the  cause  of  their  neurosis, 
is  subjected  to  excessive  abuse.  The  physicians  will  have  to 
accustom  themselves  to  explaining  to  the  official  who  has  "  over- 
taxed" himself  in  his  office  or  the  housewife  whose  household 
duties  have  been  "  too  hard  "  that  they  are  not  sick  because  they 
have  sought  to  perform  duties  really  easy  for  a  civilized  brain  but 
because  they  have  in  the  meantime  grossly  neglected  and  stifled 
their  sexual  life.  Whoever  approaches  the  cases  from  this  side 
will  find  the  proof  of  how  valuable  for  the  anamnesis  are  these 
points  of  view.  Naturally,  he  who  would  convince  himself  from 
his  patients  whether  or  not  their  neuroses  are  really  connected 
with  their  sexual  life,  cannot  avoid  making  express  inquiries 
regarding  their  sexual  life  and  giving  a  truthful  explanation  of 
the  same  without  being  diverted  from  this  medical  duty  by  ethic- 
ally colored  arguments.  It  would  facilitate  his  task  if  the  patients 
might  know  with  what  certainty  the  trained  physician  can  now 
detect  the  meaning  of  their  neurotic  difficulties  and  the  inference 
from  these  to  the  real  sexual  etiology.  The  semblance  of  negative 
cases  without  sexual  etiology,  which  might  be  given  by  a  negative 
result  of  the  examination,  is  explained  by  the  fact  that  behind  such 
cases  is  an  hysteria  (anxiety-hysteria)  or  obsessional  neurosis 
which  the  actual  neurosis  merely  imitates.  Such  hysterias  in  the 
form  of  neurasthenia  are  not  at  all  rare;  a  more  penetrating  in- 
vestigation by  means  of  psycho-analysis  invariably  unmasks  them. 
For  the  very  frequent  mixed  forms  of  true  and  psycho-neuroses, 
it  is  recommended  in  many  cases  to  overlook  at  first  the  psycho- 
neurotic component  in  the  clinical  picture  and  to  combat  thera- 
peutically the  true  neurosis ;  in  this  way  one  can  sometimes  succeed 
in  becoming  master  also  of  the  separated  psychoneurosis. 

The  anxiety-neurosis  is  such  a  widespread  malady  that  it  is 
daily  encountered  in  practice.  Its  prevention  would  be  a  weighty 
social  task;  still,  the  elimination  of  certain  injuries  is  dependent 


30  freud's  theory  of  the  neuroses 

on  so  many  material  and  social  factors  that  an  ideal  accomplish- 
ment of  the  task  under  present  civilized  conditions  is  not  to  be 
thought  of.  This  much  can  be  said,  that  only  an  individual  who 
has  no  great  sexual  appetite  can  endure  abstinence  and  that  the 
entire  abstinence  before  marriage  is  not  to  be  generally  recom- 
mended, let  alone  demanded,  since  it  can  lead  in  many  cases  to 
deficient  capacity  for  work  and  indeed  directly  to  a  neurosis.  Still, 
complete  abstinence  is  repeatedly  harmless  just  as  frustrated 
excitement  or  methods  of  imperfect  gratification  are.  Finally,  if 
it  is  necessary  for  a  married  couple  to  go  without  children,  harm- 
less measures  for  the  prevention  of  conception  must  be  employed 
which  are  suited  to  the  tolerance  of  the  individuals  participating. 
That  from  this  standpoint  a  liberal  legislation  in  relation  to  the 
introduction  of  artificial  abortion  may  be  favored  is  conceivable.®^ 
Thus,  here  again,  just  as  in  the  prophylaxis  of  neurasthenia,  it  is 
shown  that  these  neuroses  are  rooted  in  a  true  sense  in  our  whole 
present-day  sexual  morality  and  that  only  a  thorough  change  of 
our  entire  social  and  economic  organization  can  bring  humanity 
the  solution  of  the  old  inherited  evil  of  nervousness. 

"Compare  Wittels,  "Die  sexuelle  Not."    C.  W.  Stern,  Vienna  and 
Leipzic,  1909.  V 


CHAPTER   III 

THE  SEXUAL  INSTINCT 

Existence  and  Significance  of  Sexuality  in  Children ;  Opposition  to  the 
Acceptance  of  This  Discovery.  The  Sexual  Theory:  A.  Infantile  Sexu- 
ality: I.  Sexuality  of  the  Suckling.  2.  Sexuality  in  Children.  3.  Changes 
at  Puberty.  B.  The  Deviations  of  the  Sexual  Instinct:  Inversion,  Per- 
version, Fetichism,  Sadism,  Masochism,  Exhibitionism,  etc.  C.  Sexuality 
of  Neurotics.  Confirmation  of  the  Theory  by  Analysis  of  Neuroses  of 
Children.  Infantile  "  Sexual  Theories."   Nuclear-Complex  of  the  Neuroses. 

Freud  has  discovered  by  way  of  psycho-analysis  the  existence 
of  a  sexual  life  in  children  and  has  described  the  phenomena  in 
detail  in  his  classic,  "  Drei  Abhandlungen  zur  Sexualtheorie."  The 
entirely  new  conception  that  the  pure,  innocent  child  could  have 
a  sexual  life  met  much  opposition.  Besides  this  sentimental  oppo- 
sition, there  is  the  infantile  amnesia  which  veils^^  the  first  years  of 
childhood  for  most  people  up  to  the  sixth  or  eighth  year  and 
hinders  their  acknowledging  the  fact  of  infantile  sexuality.  And 
still  we  know  that  our  memory  can  be  fully  reviewed  and  repro- 
duced at  no  time  of  life ;  on  the  other  hand,  psycho-analysis  has 
shown  that  the  very  impressions  which  we  have  forgotten  leave 
behind  the  deepest  traces  in  our  mental  life  and  have  become 
determining  for  our  whole  later  development.  Thus,  there  can 
be  no  real  forgetting  of  childhood  impressions,  but  only  an  amnesia 
like  that  which  we  observe  in  neurotics  for  their  later  experiences, 
the  essential  feature  of  which  is  a  mere  detention  of  consciousness 
(repression).  This  is  the  first  amnesia  which  appears  in  the  life 
of  an  individual  and  it  seems  probable  that  no  hysterical  amnesia 
would  be  possible  without  this  infantile  amnesia. 

It  is  the  same  with  the  observations  of  sexual  expressions  in 

"This  amnesia  for  the  first  years  of  childhood  is  not  a  complete  one 
but  is  broken  through  by  entirely  isolated  childhood  memories  of  indif- 
ferent and  secondary  content  behind  which,  however,  is  hidden  a  weighty 
and  important  content  which  may  be  shown  by  psycho-analysis.  Freud 
has  called  these  "  cover-memories "  because  they  serve  as  substitutes  for 
the  really  important  impressions,  the  direct  reproduction  of  which  meets  a 
resistance.     (Compare  Lit.  No.  13.) 

31 


32  FREUD  S  THEORY   OF  THE   NEUROSES 

childhood  as  with  many  other  observations,  they  only  really  im- 
press one  when  they  are  examined  and  described  collectively.  The 
physicians  who  have  once  directed  their  attention  to  this  side  of 
the  child's  mental  life  will  find'*  in  every  case  traces  of  a  sexual 
instinct  early  expressing  itself;  hence  Freud  can  assert  without 
injustice  that  the  time  will  soon  come  when  one  will  publish  as 
rare  exceptions  cases  which  in  no  way  betray  expressions  of  sex- 
uality in  the  first  years  of  life. 

A.  The  Infantile  Sexuality 

I.  Sexuality  in  the  Suckling. — Freud  has  emphasized  the  fact 
that  the  child  brings  with  it  into  the  world  the  germ  of  sexuality 
and  enjoys  in  the  taking  of  nourishment  sexual  pleasure  which  it 
ever  after  seeks  to  procure  by  sucking,  independent  of  the  taking 
of  food.  The  Hungarian  pediatrist.  Dr.  Lindner,  has  devoted  a 
penetrating  study  to  the  sucking  or  pleasure-sucking  of  children.'^ 
The  sucking  which  appears  in  the  suckling  and  if  it  becomes  fixed 
as  a  childish  fault  can  be  continued  even  up  to  the  years  of 
maturity,  consists  in  a  rhythmically  repeated  sucking  movement 
with  the  mouth  (lips)  in  which  the  object  of  taking  nourishment 
is  excluded.  One  part  of  the  lips  or  any  other  skin  surface  which' 
can  be  reached,  perhaps  the  big  toe,  is  taken  as  the  object  on  which 
the  sucking  is  carried  out.  Therewith  appears  a  complete  absorp- 
tion of  the  attention  and  the  "pleasure-sucking"  ends  in  falling 
asleep  or  even  in  a  kind  of  orgasm.*"  Often,  there  is  combined 
with  the  pleasure-sucking  a  rubbing  of  certain  sensitive  parts  of 
the  body,  the  breast,  the  external  genitals,  etc.  In  this  way,  many 
children  proceed  from  sucking  to  masturbation.  There  is  no 
doubt  that  we  are  here  dealing  with  a  sexual  condition  which  pre- 
sents, however,  many  difficulties  to  its  comprehension,  since  the 
instinct  is  not  directed  toward  other  persons  but  is  gratified  on 
the  child's  own  body  in  a  manner  called  by  H.  Ellis,  "  autoerotic." 
In  this  connection,  the  mouth  and  lips  are  revealed  as  erogenous 

•*  Compare  for  example  Bleuler's  work  on  "  Sexuelle  Abnormitaten 
der  Kinder"  (Jahrbuch  d.  schweiz.  Ges  f.  Schulgesundheitspflege,  IX, 
1908). 

'*  Jahrbuch  fur  Kinderheilkunde,  N.  R,  XIV,  1879. 

"Here  is  already  shown  something  which  is  applicable  to  the  whole 
of  life,  namely,  that  sexual  gratification  is  the  best  hypnotic.  Most  cases 
of  nervous  insomnia  go  back  to  lack  of  sexual  gratification. 


THE   SEXUAL   INSTINCT  33 

zones,  a  significance  which  they  retain  in  later  normal  life  in  the 
kiss.  For  many,  it  may  occasion  surprise  to  learn  that  sucking 
is  exhibited  independently  of  its  relation  to  the  hunger  instinct. 
It  is,  however,  plain  that  the  mouth  zone  is  at  first  concerned 
only  with  the  gratifying  of  the  hunger  instinct;  later,  the  desire 
for  a  repetition  of  pleasurable  experiences  gained  in  this  way  is 
separated  from  the  need  of  taking  nourishment,  thereby  trans- 
forming this  mucous  surface  into  an  erogenous  zone.  It  is  to  be 
assumed  that  even  those  children  who  later  remain  normal  had  the 
childish  fault  of  sucking  in  whom  the  erogenous  importance  of  the 
lip  zone  was  constitutionally  strengthened.  If  this  accentuation 
persists,  these  children  as  adults  become  passionately  fond  of  kiss- 
ing, tend  to  perverse  kissing  or  if  men  show  a  strong  tendency  to 
smoking  and  drinking.  If  the  repression  intervenes,  however, 
then  there  is  produced  an  aversion  for  eating  and  hysterical  vomit- 
ing. Because  of  these  different  functions  of  the  lip-zone,  the 
repression  is  carried  over  to  the  hunger  instinct.  All  later  hyster- 
icals  with  disturbances  of  eating,  globus,  snoring  in  the  throat  and 
vomiting  have  during  childhood  been  energetic  suckers. 

Both  the  essential  characteristics  of  infantile  sexual  expres- 
sion which  the  sucking  displays,  namely,  autoeroticism  and  the 
domination  of  the  erogenous  zones,  exhibit  also  the  other  activities 
of  the  infantile  sexual  instinct.  Thus,  in  particular,  the  mastur- 
bation of  the  suckling  which  scarcely  an  individual  escapes  and 
which  is  plainly  appointed  to  fix  the  future  primacy  of  the  genital 
zone  for  the  later  sexual  functions.  The  action  which  allays  the 
irritation  and  furnishes  the  gratification  consists  of  a  rubbing  fric- 
tion with  the  hand  or  a  pressure  of  the  tightly  approximated  thighs. 

To  one  who  is  little  acquainted  with  neurotics  and  who  has  not 
encountered  these  phenomena  in  adult  patients  in  their  full  im- 
portance, Freud's  disclosure  that  the  anal  zone  of  the  child  may 
afford  pleasurable  sensations  seems  at  first  hardly  conceivable.'^ 
Nevertheless,  one  can  occasionally  observe  in  little  children  that 
they  refuse  to  empty  the  bowels  when  they  are  placed  on  the  closet 
because  they  obtain  pleasure  from  defecation  when  the  retained 
stool  by  its  accumulation  excites  strong  muscular  contractions  and 
in  the  passage  through  the  anus  produces  a  strong  irritation  of  the 
mucosa.     Therewith,  the  pleasurable  sensation  must  be  realized 

"Remains  of  continued  " analeroticism "  are  often  found  in  adults. 


34  FREUD  S  THEORY  OF  THE   NEUROSES 

besides  the  painful  one.  The  frequent  intestinal  catarrhs  of  child- 
hood afford  occasion  for  intense  excitement  of  these  erogenous 
zones.  Intestinal  catarrh  in  the  youngest  years  makes  the  patients 
"  nervous  "  as  it  is  called.  In  later  neurotic  maladies,  these  exert 
a  determining  influence  on  the  symptomatology  of  the  neurosis, 
placing  at  its  disposal  the  whole  range  of  intestinal  disturbances. 
Thus,  the  original  masturbationary  irritation  of  the  anal  zone 
which  is  often  practiced  by  older  children  and  adult  neurotics  with 
the  aid  of  the  fingers  is  one  of  the  roots  of  the  constipation  so 
frequently  found  in  neuropaths.  The  great  importance  of  the  anal 
zone  is  reflected  in  the  fact  that  one  finds  only  few  neurotics  who 
have  not  their  special  skatalogical  customs,  ceremonials,  etc.  It 
is  just  these  coprophiliacs,  that  is,  those  who  associated  pleasur- 
able emotions  with  the  excements  in  childhood,  who  are  most 
profoundly  perplexed  by  the  repression;  Freud  has  shown  the 
important  part  which  these  instinctive  impulses  destined  to  be  sup- 
pressed play  in  the  later  character  formation.  Psycho-analysis  of 
neurotics  revealed  the  fact,  purely  empiric,  that  individuals  who 
have  successfully  repressed  an  anal  eroticism,  which  was  originally 
intense,  regularly  show  certain  traits  of  character  in  unmistakable 
form:  orderliness,  frugality,  and  stubbornness.'^ 

Also  entirely  new  is  the  Freudian  discovery  that  the  neck  of 
the  bladder  can  serve  as  an  erogenous  zone.  Pollution  in  the  child 
lacking  a  sexual  secretion  seems  to  take  the  form  of  an  excretion 
of  urine  and  may  lie  at  the  bottom  of  many  cases  of  eneuresis. 
Further,  in  later  life,  especially  in  neurotics  there  occurs  simul- 
taneously with  the  sexual  excitement  a  desire  to  micturate  and 
urination  very  frequently  appears  in  dreams  as  the  symbol  of  the 
sexual  act.'®  The  bed-wetting  which  plays  a  great  role  in  the 
previous  histories  of  neurotics  is  repeatedly  closely  connected  with 
masturbation. 

The  sources  of  all  these  sexual  excitements  lie  in  part  in  in- 
ternal processes,  in  part  are  brought  about  through  peripheral 
irritation  of  these  zones  (anal,  genital)  by  the  cleansing  as  well 
as  by  caressing  of  parents  and  nurses. 

*  For  the  attempt  at  a  psychological  explanation  of  the  connection, 
compare  Freud,  "  Charakter  und  Analerotik,"  Lit.  No.  29. 

**  The  biological  problems  connected  with  the  theory  of  the  erogenous 
zones  are  treated  in  a  valuable  "  Studie  fiber  Minderwertigkeit  von 
Organen,"  by  Dr.  Alf.  Adler  (Urban  &  Schwarzenberg,  Vienna  and  Ber- 
lin, 1907). 


THE   SEXUAL   INSTINCT  35 

These  germs  of  sexual  excitement  in  the  new  born  develop  for 
a  time,  then  undergo  a  progressive  suppression  in  a  "  latent  period  " 
which  is  normally  interrupted  about  the  third  or  fourth  year, 
During  this  period  of  complete  or  merely  partial  latency,  as  a 
result  of  organic  processes  (organic  repression)*"  and  the  indis- 
pensable help  of  the  education,  the  mental  forces  are  formed  which 
appear  later  as  inhibitions  to  the  sexual  instinct  and  narrow  its 
course  like  dams:  the  disgust,  the  feeling  of  shame,  the  esthetic 
and  moral  standards  of  ideas.  During  the  latent  period,  another 
part  of  these  sexual  energies  is  separated  from  the  sexual  aim  and 
applied  to  cultural  and  social  ends,  a  process  which  Freud  has 
designated  by  the  name  sublimation  as  important  for  culture,  his- 
tory and  the  individual.  The  possibility  of  certain  components 
of  the  sexual  instinct  being  diverted  from  the  original  goal  to  a 
higher  and  no  longer  sexual  aim  furnishes  in  later  life  additional 
energies  to  our  mental  powers;  to  these,  we  probably  owe  our 
highest  cultural  attainments. 

From  this  point  of  view,  the  often  expressed  skepticism  regard- 
ing the  specific  virulence  of  the  sexual  etiology  loses  its  justifica- 
tion. No  instinct  so  important  and  necessary  for  the  furtherance 
of  culture  is  limited  and  suppressed  like  the  sexual  instinct,  from 
childhood  on,  chiefly  in  its  perverse  manifestations.  The  afflic- 
tions known  as  neuroses  are  to  be  traced  back  to  the  manifold 
forms  of  misfortune  which  may  befall  this  transformation  process 
of  the  components  of  the  sexual  instinct. 

2.  Sexuality  in  Children. — The  sexuality  of  the  suckling  re- 
turns in  the  years  of  childhood,  although  a  fixed  time  for  this  can- 
not be  named.  This  reappearance  of  sexual  activity  is  determined 
by  internal  causes  and  external  conditions.  At  the  head,  stands 
the  influence  of  seduction,  which  treats  the  child  prematurely  as 
sexual  object.  Recent  investigations  have  shown  that  the  child 
now  and  then  very  prematurely,  at  the  age  of  three  to  five  years, 
is  capable  of  a  choice  of  an  object  accompanied  by  affects  and  not 
merely  of  a  series  of  autoerotic  gratifications.  This  premature 
sexual  appetite  is  directed  at  first  toward  the  parents  and  nurses, 
a  choice  of  object  which  springs  from  the  dependency  of  the  child. 

**  The  nature  of  this  process  which  corresponds  in  a  way  to  an  organic 
developmental  tendency  is  still  unexplained;  its  importance  for  the  origin 
of  the  psychoneuroses  is  pointed  out  in  the  chapter  on  hysteria. 


36  freud's  theory  of  the  neuroses 

One  can  also  observe  without  trouble  that  the  apparently  most 
harmless  love  affairs  of  little  children  are  not  without  an  erotic 
tinge.*^ 

It  is  obvious  that  seduction  is  not  necessary  to  awaken  the 
sexual  life  of  the  child  in  this  second  period  and  that  such  awak- 
ening can  also  occur  spontaneously  from  internal  causes.  It  is 
now  instructive  to  observe  that  the  child  under  the  influence  of 
occasional  seduction  can  become  polymorphous-perverse,  that  is 
to  say,  can  be  seduced  to  all  possible  transgressions;  this  shows 
that  it  brings  along  within  its  own  person  the  possibility  for  this 
condition.  It  brings  with  it  the  tendency  to  all  perversions  and  as 
a  result  of  its  bisexual  nature  also  the  tendency  toward  inversion 
(homosexuality) ;  its  development  either  into  a  neurosis  or  nor- 
mality is  conditioned  on  the  special  emphasis  of  certain  instincts 
and  zones  as  well  as  on  the  experiences  of  childhood.  All  the 
peculiarities  of  this  second  infantile  sexual  activity  lie  behind  the 
deepest  impressions  in  the  (unconscious)  memory  of  the  indi- 
viduals and  condition  the  development  of  their  characters  if  they 
remain  healthy,  of  the  symptomatology  of  their  neuroses  if  they 
become  afflicted  with  one  after  puberty.  In  the  latter  case,  one 
finds  this  sexual  period  forgotten  and  the  conscious  memories 
formed  of  it  displaced.  Freud,  however,  also  brings  the  normal 
infantile  amnesia  into  connection  with  this  infantile  sexual  activ- 
ity. Through  psycho-analytic  investigation,  it  has  been  possible 
to  render  this  forgotten  material  conscious  and  thereby  overcome 
an  obsession  which  came  from  the  unconscious  psychic  material. 

The  perversions  contained  in  the  polymorphous-perverse  tend- 
encies may  be  traced  back  to  a  series  of  partial  or  component 
instincts  which  in  themselves,  however,  are  not  primary.  Besides 
an  instinct  not  itself  sexual  arising  from  motor  impulse  sources, 
one  distinguishes  in  these  a  contribution  from  an  irritation  of  the 
receptive  organ  (skin,  mucosa,  sense  organ)  of  the  erogenous  zones, 
the  excitation  of  which  lends  to  the  instinct  the  sexual  character; 
as  such  partial  or  component  instincts,  Freud  has  revealed  exhibi- 
tionism, the  peeping  tendency,  active  and  passive  algolagnia 
(sadism  and  masochism)  and  others.  The  undisguised  pleasure 
of  the  little  child  in  the  undressing  of  its  body  and  in  particular 

**  Compare  the  interesting  work  of  Sanford  Bell, "  A  preliminary  study 
of  the  emotion  of  love  between  the  sexes"  (Atner.  Jour.  Psych.,  1902). 


THE  SEXUAL  INSTINCT  37 

of  its  genital  parts  shows  the  exhibitionistic  tendency.  The  coun- 
terpart of  this  in  later  life  as  a  perverse  tendency  is  the  curiosity 
to  see  the  genitals  of  other  persons  (Schaulust,  peeping  tendency) 
which  under  suitable  influence  can  attain  a  great  importance  for 
the  sexual  life  of  the  child.  Looking  at  and  handling  the  genitals 
of  playmates  is  not  rare  and  such  children  become  voyeurs  (peep- 
ers), ardent  observers  of  the  micturition  and  defecation  of  others. 
The  roots  of  sadism  are  easily  detected  in  normal  individuals  in 
the  aggression  which  the  sexuality  of  most  male  individuals 
exhibits,  the  biological  importance  of  which  may  lie  in  the  neces- 
sity of  overcoming  the  resistance  of  the  sexual  object  otherwise 
than  by  the  act  of  courtship.  Thus,  sadism  corresponds  to  an 
aggressive  component  of  the  sexual  instinct  which  has  become 
independent  and  exaggerated  through  having  been  moved  by  dis- 
placement to  a  preponderating  influence.  Nevertheless,  the  com- 
plete psychological  analysis  of  the  sadistic  instinct  has  not  yet 
succeeded.  Also  for  masochism,  a  normal  root  cannot  be  denied 
in  the  sexual  overvaluation  (compare  later).  As  a  further  root 
of  masochism,  the  painful  irritation  of  the  skin  of  the  buttocks  in 
spanking  is  to  be  emphasized. 

The  study  of  the  component  instincts  revealed  the  important 
discovery  that  the  sexual  instinct  itself  is  not  a  unit  but  a  com- 
posite structure  of  many  components  which  are  again  set  free  in 
the  perversions. 

For  the  origin  of  sexual  excitation  in  this  second  period  of 
sexuality  in  childhood,  we  go  back  to  the  following :  (a)  To  an 
imitation  of  a  gratification  experienced  in  connection  with  other 
organic  processes  (for  example,  sucking)  ;  (b)  to  suitable  periph- 
eral irritation  of  erogenous  zones;  (c)  to  the  expression  of  some 
instinct,  the  origin  of  which  is  not  entirely  plain  to  us  as  yet,  as 
the  peeping  tendency  (Schautrieb)  and  the  tendency  to  cruelty. 

Rhythmical  mechanical  movements  of  the  body  likewise  cause 
pleasurable  sensations;  hence,  swinging,  being  tossed,  rocking,  as 
well  as  railroad  and  carriage  journeys  are  so  much  liked  by 
children.*^     That  the  muscular  activity  set  up  by  scuffling  and 

**  Freud  thinks  that  we  may  assume  that  these  influences  which  in  mild 
intensity  are  sources  of  sexual  excitement  may  have,  when  connected  by 
fright  with  violent  mechanical  shaking,  an  etiological  significance  for 
hysteriform  traumatic  neurosis.  He  has,  however,  not  yet  taken  trau- 
matic hysteria  into  the  scope  of  his  investigation. 


38  freud's  theory  of  the  neuroses 

wrestling  with  playmates  can  serve  as  a  sexual  excitation  is  also 
recognized.  Fear  and  anxiety  can  likewise  call  forth  sexual  excita- 
tion, in  connection  with  which  the  feelings  of  irritation  caused 
by  anxiety  in  school  children  which  can  then  lead  to  onanism  and 
pollution  may  be  particularly  mentioned.  Finally,  it  is  undeniable 
that  the  concentration  of  the  attention  on  an  intellectual  task  in 
young  or  mature  persons  may  result  in  a  coincident  sexual  excita- 
tion ;  this  is  probably  the  only  just  ground  for  attributing  nervous 
disturbances  to  intellectual  overwork,  a  cause  formerly  assigned 
but  always  doubtful. 

3.  The  Changes  at  Puberty. — The  latent  period  lasts,  apart 
from  the  interruptions  mentioned,  up  to  the  changes  at  puberty 
in  which  the  heretofore  autoerotic  character  of  the  sexual  activity 
is  lost  and  the  instinct  finds  its  object.  Until  now,  this  was  com- 
posed of  separate  instincts  and  derived  from  erogenous  zones 
which  sought  independently  of  one  another  a  certain  pleasure  as 
the  only  sexual  goal.  The  new  sexual  aim  which  is  created  by  the 
changes  of  puberty  and  is  characterized  by  an  amalgamation  of 
all  instinctive  tendencies  which  proceed  from  the  erogenous  zones 
consists  in  the  man  in  the  discharge  of  the  sexual  product ;  for  the 
accomplishment  of  this,  there  must  be  a  subordination  of  all  the 
erogenous  zones  to  the  primacy  of  the  genital  zone,  which  is  facili- 
tated by  the  development  of  the  genital  organs  and  the  elaboration 
of  the  seminal  secretion.  To  the  conditions  which  first  appear  at 
puberty,  there  is  also  added  that  "pleasure  of  gratification" 
(Befriedigungslust)  of  sexuality  which  ends  the  normal  sexual 
act:  the  end-pleasure  (Endlust).  The  pleasure  derived  previously 
from  the  excitation  of  the  erogenous  zones  needs  a  name  for  itself 
and  is  called  in  contrast  by  Freud,  the  fore-pleasure  (Vorlust).*' 
The  finding  of  an  object  is  influenced  by  the  infantile  inclination 
of  the  child  towards  its  parents  and  nurses  which  is  revived  at 
puberty  and  similarly  directed  by  the  incest  barriers  against  these 
persons  which  have  been  erected  in  the  meantime. 

Both  these  essential  changes  at  puberty,  the  primacy  of  the 
genital  zone  and  the  finding  of  an  object,  are  indispensable  for  the 
establishment  of  a  normal  sexual  life.    If,  on  account  of  patho- 

*"  Later  material  on  the  mechanism  of  the  fore-pleasure  as  well  as  on 
the  nature  of  pleasure  in  general  is  found  in  Freud's  work  "  Der  Witz 
und  seine  Beziehung  zum  Unbewussten "  (Lit.  No.  19). 


THE   SEXUAL   INSTINCT  39 

logical  heredity  and  accidental  experiences,  this  amalgamation  of 
the  excitations  springing  from  various  sources  and  its  application 
to  the  sexual  object  does  not  occur,  then  there  results  the  patho- 
logical deviations  of  the  sexual  instinct,  determined  in  part  by 
earlier  processes,  such  as  a  preservation  of  a  definite  part  of  the 
original  polymorphous-perverse  tendency.  The  perversions  are 
thus  developed  from  seeds  which  are  present  in  the  undifferen- 
tiated tendencies  of  the  child  and  constitute  in  adults  a  condition 
of  arrested  development. 

Puberty  is  also  the  period  in  which  the  development  of  the 
two  sexes  widely  diverges  in  respect  to  the  new  sexual  aim.  That 
of  the  male  is  of  the  more  far  reaching  influence,  while  in  the 
female,  a  kind  of  retrograde  process  sets  in.  The  autoerotic 
activity  of  both  sexes  has  been  the  same,  and  in  respect  to  the 
manifestation  of  masturbation  in  the  genital  zone  one  could  make 
the  statement  that  the  sexuality  of  the  little  girl  has  throughout  a 
masculine  character.  The  chief  erogenous  zone  in  the  female 
child  is  situated  in  the  clitoris,  the  homologue  of  the  glans  of 
the  male  penis.  This  excitability  of  the  clitoris,  however,  at 
puberty,  which  brings  a  great  influx  of  libido  to  the  boy,  under- 
goes a  new  repression.  Thus,  it  is  a  characteristic  of  male  sexual 
life  which  the  repression  thereby  destroys.  The  transference  of 
the  excitability  of  the  clitoris  to  the  vaginal  entrance  often  takes 
a  certain  time  for  its  accomplishment  during  which  the  young 
woman  is  often  anesthetic  for  coitus.  If  the  clitoris  zone  attempts 
to  retain  the  great  activity  which  it  had  in  childhood  and  refuses 
to  give  up  its  excitability,  then  the  anesthesia  becomes  permanent. 
In  this  vicissitude  of  the  chief  erogenous  zone  as  well  as  in  the 
new  increase  of  repression  at  puberty  lie  the  chief  conditions  for 
the  predisposition  of  the  woman  for  a  neurosis,  especially  hysteria. 
If  one  would  give  a  definite  meaning  to  the  terms  masculine  and 
feminine,  he  could  make  the  assertion  that  libido  is  regularly  and 
lawfully  a  masculine  attribute  whether  it  occurs  in  man  or  woman 
and  not  taking  its  object  into  account  which  may  be  either  man 
or  woman. 

B.  Deviations  of  the  Sexual  Instinct 

By  the  aid  of  the  analytic  investigation  of  the  sexual  instinct 
in  the  neurotic,  Freud  has  been  able  to  interpret  exhaustively  the 


40  FREUD  S  THEORY  OF  THE   NEUROSES 


*l 


pathological  deviations  of  the  instinct  of  sex  and  to  indicate  its 
relation  to  the  normal.  These  deviations  are  not  to  be  considered 
a  priori  pathological,  but  only  in  their  exclusiveness  and  fixation 
lies  the  justification  for  considering  the  so-called  perversions 
symptoms  of  disease.  Freud  has  greatly  illuminated  this  extended 
field  of  phenomena,  in  doing  which  he  divides  the  perversions  into 
two  groups,  according  as  the  deviation  concerns  the  sexual  object 
or  the  sexual  aim. 

I.  Deviations  in  Respect  to  the  Sexual  Object. — Among  these, 
inversion,  as  Freud  calls  homosexuality,  shows  the  greatest  diver- 
sity and  therefore  the  most  difficult  problems.  The  persons  hav- 
ing this  perversion  are  either  (a)  absolutely  inverted,  that  is, 
their  sexual  object  can  belong  only  to  the  same  sex;  {b)  amphi- 
genously  inverted  (psycho-sexual  hermaphrodites),  that  is,  their 
sexual  object  can  belong  to  the  same  sex  or  to  the  opposite  sex; 
(c)  occasionally  inverted.  A  satisfactory  explanation  of  inversion 
is  afforded  only  by  the  perception  that  there  is  in  everyone  an 
original  bisexual  tendency  which  is  also  established  anatomically. 
Normal  development  leads  from  bisexuality  to  the  primacy  of  the 
heterosexual  instinct ;  thus,  inversion  corresponds  to  a  disturbance 
of  development.  In  this  perception,  the  inadequate  question  of 
whether  it  is  inborn  or  acquired  disappears.  It  arises  undoubtedly 
in  earliest  childhood  and  has  as  a  foundation,  disturbances  which 
the  sexual  instinct  encounters  in  its  development.  In  every  case, 
it  is  absolutely  inadmissible  to  differentiate  a  special  homosexual 
instinct;  it  is  not  a  peculiarity  of  the  instinctive  life  but  of  the 
choice  of  an  object  which  constitutes  the  homosexual.  The  prob- 
lem of  homosexuality  is  a  very  involved  one  and  embraces  quite 
different  types  of  sexual  activity  and  development.  One  should 
expressly  distinguish  whether  the  inversion  has  inverted  the  sexual 
character  of  the  object  or  that  of  the  subject.  The  sexual  object 
of  the  male  invert  is  frequently  not  of  the  same  sex  in  his  essential 
characteristic  but  a  union  of  the  characteristics  of  both  sexes 
with  the  fixed  condition  of  masculinity  of  body  (genitals).  The 
analysis  of  the  phobia  of  a  five  year  old  boy  brought  Freud  the 
explanation  of  this  condition.  One  finds  among  homosexuals  in 
later  life,  who  according  to  Freud's  and  Sadger's**  observations 

**  J.  Sadger :  "  Fragment  der  Psychoanalyse  eines  Homosexuellen " 
(Jahrb.  f.  sex.  Zwischenstufen,  1908).     Same,  "Zur  Atiologie  der  kon- 


THE   SEXUAL   INSTINCT  4I 

pass  through  in  childhood  an  amphigenous  stage,  the  same  infantile 
overvaluation  of  the  genitals,  especially  of  the  penis  as  distin- 
guished this  little  patient.  This  premature  preponderance  of  the 
masculine  organ  determines  the  fate  of  the  homosexual.  They 
choose  the  woman  as  the  sexual  object  in  their  childhood  so  long 
as  they  presuppose  in  woman  the  existence  of  that  part  of  the 
body  which  is  apparently  indispensable  to  them ;  with  the  convic- 
tion that  the  woman  has  deceived  them  in  this  point,  the  woman 
ceases  to  be  acceptable  as  sexual  object.  They  cannot  do  without 
the  penis  on  the  person  who  should  stimulate  them  to  sexual  inter- 
course and  in  favorable  cases  fix  their  libido  upon  the  "  woman 
with  the  penis,"  the  youth  of  effeminate  appearance.  The  homo- 
sexuals have  thus  remained  fixed  during  the  course  of  develop- 
ment from  autoeroticism  to  love  of  an  object  in  a  position  nearer 
autoeroticism.  The  presupposition  of  a  penis  on  the  woman  is 
one  of  those  frequent  infantile  sexual  theories  developed  by  the 
still  unenlightened  child  whose  sexual  curiosity  is  already 
awakened. 

Although  psycho-analysis  has  as  yet  furnished  no  complete 
explanation  of  the  origin  of  inversion,  still  it  can  disclose  the 
psychic  mechanism  in  certain  cases  and  enrich  the  discussion  con- 
cerning this.  In  the  cases  thus  far  investigated,  it  can  be  asserted 
that  those  who  later  become  inverted  pass  through  during  the  first 
years  of  childhood  a  phase  of  very  intense  but  short-lived  fixation 
on  the  woman  (usually  the  mother),  after  the  conclusion  of  which 
they  identify  themselves  with  the  woman  and  take  themselves  for 
the  sexual  object,  that  is,  proceeding  from  narcism,  they  seek 
young  men  like  their  own  person  whom  they  wish  to  love  as  the 
mother  loved  them.  In  this  connection,  it  has  been  discovered  that 
the  supposed  inverted  were  in  no  way  insusceptible  to  the  stimulus 
of  the  woman  but  the  excitement  called  forth  by  the  woman  is 
continually  transposed  to  a  male  object.  Thus  they  repeat  during 
their  whole  life  the  mechanism  by  which  their  inversion  was  occa- 
sioned. Their  obsessional  striving  after  the  man  shows  itself  as 
conditioned  by  their  restless  flight  from  the  woman.  Meanwhile, 
it  is  to  be  noticed  that  thus  far  psycho-analysis  has  undertaken 
to  analyze  only  a  few  types  of  inversion :  persons  with  generally 

traren  Sexualempfindung "  {Mediz.  Klinik,  1909).  Same,  "1st  die  kon- 
trare  Sexualempfindung  heilbar?"  {Zeitschr.  f.  Sexualwissenschaft,  1908). 


42  FREUDS   THEORY  OF   THE   NEUROSES 

restricted  sexual  activity  whose  sexuality  is  exhibited  as  inversion. 
The  development  of  homosexuality  seems  further  to  be  favored 
for  both  sexes  by  purely  feminine  surroundings  during  the  period 
of  growth. 

Exceptionally,  sexually  immature  persons  and  animals  may 
also  be  taken  as  sexual  objects,  thus  throwing  a  light  on  the  nature 
of  the  sexual  instinct  which  in  contrast  to  hunger  permits  of  so 
many  kinds  of  variations  and  such  a  degradation  of  its  object. 

2.  The  deviations  in  respect  to  the  sexual  aim  which  are  de- 
scribed as  perversions  Freud  divides  into  (a)  anatomic  trans- 
gressions of  the  portions  of  the  body  appointed  for  the  sexual 
union;  (b)  lingering  over  the  intermediary  relations  to  the  sexual 
object  which  should  normally  be  passed  through  quickly  on  the 
way  to  the  final  sexual  goal.  In  the  most  normal  sexual  process, 
those  steps  are  already  discernible,  the  development  of  which  leads 
to  the  deviations  which  are  called  perversions. 

(a)  The  psychic  valuation  which  the  sexual  object  shares  as 
the  wish-goal  of  the  sexual  instinct  is  limited  in  the  rarest  cases 
to  the  genitals  but  usually  encroaches  on  the  whole  body  and 
radiates  to  the  psychic  field.  It  is  this  psychic  "  sexual  overvalua- 
tion "  which  endures  so  badly  the  limitation  of  the  sexual  aim  and 
helps  to  bring  other  parts  of  the  body  to  serve  as  sexual  goals. 
In  the  elaboration  of  these  most  varied  anatomical  transgressions, 
a  need  for  variation  is  unmistakable.  The  importance  of  the 
agency  of  sexual  overvaluation  may  be  best  studied  in  the  man 
whose  sexual  life  is  open  to  investigation  while  that  of  the  woman 
in  part  because  of  cultural  limitation,  in  part  through  conventional 
concealment  and  insincerity  is  hidden  in  darkness. 

The  application  of  the  lip  and  mouth  mucosa  to  the  normal 
kiss  is  generally  practiced  among  most  peoples.  On  the  contrary, 
against  the  union  of  the  lip-mouth-zone  with  the  sexual  organ  of 
the  other  sex  there  are  various  strong  feelings  of  disgust.  In 
this  disgust,  Freud  sees  one  of  the  forces  which  have  brought 
about  the  limitation  of  th^  sexual  aim.  As  a  rule,  these  stop  short 
of  the  genitals.  However,  if  the  genitals  become  the  object  of  the 
disgust  (sexual  refusal)  this  is  to  be  considered  a  characteristic 
sign  of  hysteria  (especially  among  females).  In  connection  with 
this,  it  may  be  noted  that  with  hystericals,  certain  other  portions 
of  the  body,  as  mouth  and  anal  mucosa,  may  assume  as  it  were  the 
significance  and  role  of  genitals. 


THE   SEXUAL   INSTINCT  43 

Freud  brings  into  connection  with  the  sexual  overvaluation 
the  common  abnormality  of  fetichism.  The  fetichistic  substitute 
for  the  sexual  object  is  in  general  a  part  of  the  body  only  slightly 
adapted  to  the  sexual  purpose  (foot,  hair)  or  an  inanimate  object 
which  stands  in  near  relation  to  the  sexual  person  (pieces  of 
clothing,  linen,  shoes,  etc.).  A  certain  degree  of  fetichism  is 
always  peculiar  to  normal  love.  This  first  becomes  pathological 
when  the  striving  after  the  fetich  becomes  fixed  and  takes  the 
place 'of  the  normal  goal.  Further,  when  the  fetich  becomes  sepa- 
rated from  the  definite  person  and  becomes  the  sole  sexual  object. 
A  certain  diminution  in  the  desire  for  the  normal  sexual  goal 
seems  to  be  a  presupposition  for  all  cases  (executive  weakness  of 
the  sexual  apparatus).  In  the  choice  of  the  fetich,  there  is  shown, 
as  Binet  first  asserted  and  as  was  later  affirmed  by  numerous 
proofs,  the  persisting  influence  of  a  sexual  impression  usually 
received  in  early  childhood.  In  other  cases,  it  is  a  symbolic  asso- 
ciation of  thoughts  usually  not  conscious  to  the  individual  which 
has  influenced  the  substitution  of  the  object  by  the  fetich.  Psycho- 
analysis could  recently  fill  out  the  previous  gaps  in  the  understand- 
ing of  fetichism  by  pointing  out  the  significance  of  a  pleasure 
derived  from  smell  (Riechlust)  for  the  choice  of  the  fetich  which 
has  been  lost  through  repression.  Feet  and  hair  are  peculiarly 
odoriferous  objects  which  after  the  renunciation  of  the  pleasure 
derived  from  the  smell  and  corresponding  idealization  are  raised 
to  fetiches.*'  In  the  perversion  corresponding  to  the  foot- 
fetichism,  the  bad-smelling  foot  is  accordingly  the  original  sexual 
object.  Another  contribution  to  the  explanation  of  fetichistic 
preference  for  the  foot  is  revealed  in  the  infantile  sexual  theories 
to  be  discussed  later ;  the  foot  represents  the  greatly  missed  i>enis 
of  the  woman.** 

(b)  Fixations  of  temporary  sexual  goals.  All  external  and 
internal  conditions  which  render  difficult  the  attainment  of  the 
normal  sexual  aim  or  long  defer  it  (impotence,  costliness  of  the 
sexual  object,  dangers  of  the  sexual  act)  strengthen  the  tendency 

*  This  conception  is  confirmed  by  an  investigation  by  Abraham  on  a 
case  of  shoe  and  corset  fetichism  (Jahrbuch,  1910).  For  pleasure  in 
smelling,  compare  Jahrbuch,  I,  2,  page  420. 

**  The  foot  is  an  ancient  symbol  of  the  penis  long  used  in  myths  and 
corresponding  to  the  shoe  or  slipper  symbol  of  the  female  genitals.  Com- 
pare Aigremont,  "  Schuh-  and  Fuss-Fetichismus  und  Erotik,"  Leipzic,  1909. 


44  FREUD  S  THEORY  OF   THE   NEUROSES 

to  prolong  the  preparatory  acts  and  form  new  sexual  goals  from 
these  which  may  replace  the  normal.  Closer  investigation  always 
shows  that  the  apparently  most  strange  of  these  new  purposes  are 
already  hinted  at  in  the  normal  sexual  process  and  provided  by 
the  intimacies  which  serve  for  the  excitement  of  themselves  and 
the  opposite  party.  In  this  respect,  the  fondling  of  the  sexual 
object  plays  the  greatest  role.  A  certain  amount  of  fondling  and 
a  prolongation  of  the  intermediary  sexual  goal  of  sexually  toned 
looking  at  is  present  in  a  certain  degree  in  most  normal  men.  The 
pleasure  of  looking  (Schaulust)  becomes  a  perversion  (a)  when 
it  is  limited  exclusively  to  the  genitals,  (b)  when  it  is  joined  with 
the  overcoming  of  the  disgust  (voyeurs,  peepers),  onlookers  at  the 
excretory  functions,  (c)  when  it  represses  the  normal  sexual  goal 
instead  of  preparing  for  it.  The  latter  is  shown  most  clearly  in 
the  case  of  the  exhibitionists  who  display  their  genitals.  In  this 
perversion  there  stands  forth  most  distinctly  a  curious  trait  which 
is  also  sometimes  present  in  other  perversions.  The  sexual  goal 
is  really  present  here  in  double  form,  in  active  and  passive  form. 
Thus,  these  instincts  appear  in  contrasting  pairs.  The  same  is  the 
case  in  one  of  the  most  frequent  and  important  of  the  perver- 
sions, in  the  instinct  to  inflict  pain  on  the  sexual  object  (sadism) 
and  its  opposite  (masochism)  also  called  active  and  passive 
algolagnia. 

C.  The  Sexual  Instinct  of  Neurotics 

The  results  which  have  come  to  Freud  from  the  conditions 
described  are  intimately  connected  with  the  starting  point  of  his 
theory,  since  they  have  afforded  an  important  point  of  view  for 
understanding  the  sexual  instinct  of  neurotics.  Neurotics  are 
really  persons  with  strongly  formed  impulses  which  have  in  the 
course  of  development  been  repressed  and  unconsciously  become 
perverse.  Their  sexual  instinct  displays,  therefore,  all  the  devia- 
tions which  we  have  studied  as  variations  of  the  normal  and  as 
expressions  of  the  pathological  sexual  life  and  their  unconscious 
phantasies  show  during  the  process  of  rendering  these  conscious 
by  analysis  the  same  content  as  the  fixed  acts  of  the  perverts. 

(a)  In  the  unconscious  mental  life  of  all  neurotics  without 
exception,  are  found  impulses  to  inversion,*'  fixation  of  the  libido 

"  Compare  Alf.  Adler,  "  Der  psychische  Hermaphroditismus  im  Leben 
und  in  der  Neurose,"  Fortschritte  d.  Medizin,  1910. 


THE   SEXUAL    INSTINCT  45 

on  persons  of  the  same  sex,  a  discovery  which  is  of  especial  im- 
portance for  the  elucidation  of  hysteria  in  males. 

(b)  Among  the  psychoneurotics  may  be  detected  all  the  tend- 
encies to  the  anatomic  transgressions  existing  in  the  unconscious 
as  symptom-creators;  among  such  occurring  with  especial  fre- 
quency and  intensity  are  those  which  convert  the  oral  and  anal 
mucosa  to  the  role  of  genitals. 

(c)  A  most  important  role  among  the  symptom-creators  of 
the  psychoneuroses  is  played  by  the  component  instincts  which 
were  discussed  as  creators  of  the  new  sexual  goal;  these  appear 
mostly  in  contrasting  pairs,  the  peeping  tendency  and  the  exhibi- 
tionistic  tendency,  the  active  and  passive  tendency  to  cruelty.  The 
contribution  of  the  latter  is  indispensable  to  the  comprehension  of 
the  painful  nature  of  the  symptoms  and  almost  invariably  controls 
a  part  of  the  social  relations  of  the  patients.  Where  such  an  in- 
stinct which  is  capable  of  being  paired  with  an  opposite  is  found 
in  the  unconscious,  the  second  part  may  regularly  be  detected  as 
acting.  Every  active  perversion  is  thus  accompanied  by  its  pass- 
ive counterpart.  For  example,  whoever  has  difficulty  in  following 
the  repression  of  sadistic  impulses,  finds  another  entrance  to  the 
symptoms  by  way  of  the  masochistic  tendency.  The  complete  agree- 
ment with  the  conduct  of  the  corresponding  positive  perversions 
is  certainly  very  noteworthy.  In  the  clinical  picture,  however,  one 
or  the  other  of  the  contrasting  tendencies  plays  the  paramount  role. 

In  a  clear  case  of  psychoneurosis,  there  is  seldom  only  one  of 
these  perverse  tendencies  present,  usually  a  large  number  of  them 
and  as  a  rule  traces  of  all. 

The  sexuality  of  neurotics  discloses  one  kind  of  repression  of 
the  instinctive  life  which  exceeds  the  normal  amount.  The  symp- 
toms of  the  neurotic  malady  are  the  expression  of  the  sexual 
activity  of  the  patients  taken  in  the  broadest,  polymorphous- 
perverse  sense.  Thus  they  originate  not,  as  a  mistaken  conception 
of  the  Freudian  doctrine  insists,  only  at  the  expense  of  the  so- 
called  normal  sexual  instinct,  but  represent  the  converted  expres- 
sion of  instincts  which  one  must  call  perverse  (in  the  broadest 
sense).*®    The  neurotics  have,  in  a  certain  sense,  kept  the  infantile 

"Compare  W.  Strohmayer,  "Zur  Analyse  und  Prognose  psychoneu- 
rotischer  Symptome,"  Zeitschr.  f.  Psychotherapie  u.  med.  Psychologie, 
II,  2,  1910. 


46  freud's  theory  of  the  neuroses 

attitude  toward  sexuality  or  would  go  back  to  it,  but  with  the 
difference  that  with  neurotics  the  sexual  instinct  is  not  expressed 
consciously  and  actively  but  exists  in  repression,  thus  acting  in 
the  unconscious  and  there  finding  expression  only  in  the  form  of 
inhibitions.  The  neurosis  may  thus  be  called  the  negative  of  the 
perversion.  With  such  a  conception  naturally  disappears  the  con- 
tradiction that  there  may  be  persons  whose  sexual  life  has  ceased 
who  may  yet  contract  a  neurosis ;  one  should  not  forget  that  there 
may  be  a  number  of  perverse  emotions,  the  deficient  gratification 
of  which  leads  to  a  neurosis  in  the  end. 

The  sexual  instinct  of  the  neurotic  expresses  itself  before 
everything  else  in  a  spontaneous  sexual  precocity  which  shows 
itself  in  the  interruption,  shortening  or  abolition  of  the  infantile 
latent  period.  This  precocity  renders  difficult  the  later  control  of 
the  sexual  instinct  and  confers  upon  it  a  certain  amount  of  obses- 
sional character.  It  leads  further  to  an  excessive  development  of 
the  sexual  instinct  against  which,  on  the  other  hand,  the  abnormal 
(failed)  repression  stands  opposed.  Between  the  pressure  of  the 
instinct  and  the  counter  pressure  of  the  sexual  denial,  the  malady 
then  makes  its  appearance  as  a  way  out  which  does  not  solve  the 
conflict  but  seeks  to  escape  it  by  changing  the  libidinous  tendencies 
into  symptoms. 

These  were  the  results  which  Freud  had  gained  from  psycho- 
analytic investigation  of  adults  and  some  isolated  cases  of  observa- 
tions of  children.  In  an  especially  favorable  and  because  of  its 
youthful  age  most  suitable  case,  he  succeeded  later  in  confirming 
directly  this  insight  into  the  nature  of  child  sexuality  which  had 
been  established  retrospectively.  Since  the  neuroses  of  adults 
were  to  be  traced  back  in  every  case  to  the  same  basic  complexes 
as  those  the  child  showed  in  complete  distinctness  and  elaboration, 
Freud  could  claim  for  this  child-neurosis  a  typical  significance. 
This  child  analysis  showed  positively  that  the  picture  of  the  child's 
mental  life  as  it  was  presented  from  the  observation  of  the  little 
patient  by  his  parents  was  in  complete  accord  with  the  description 
which  Freud  had  sketched  in  his  sexual  theory  from  psycho- 
analytic investigations  of  adults  and  at  that  time  only  occasional 
observations  on  children.  In  the  boy's  relation  to  his  father  and 
mother,  this  case  confirmed  in  every  detail  everything  which  Freud 


THE  SEXUAL  INSTINCT  47 

had  asserted  concerning  the  sexual  relations  of  children  to  their 
parents.  The  boy  is  a  little  CEdipus  who  would  have  the  father 
out  of  the  way  in  order  that  he  might  be  alone  with  the  beloved 
mother  and  sleep  with  her.  Besides  this  typical  CEdipus-complex** 
of  sensuous  love  for  the  mother  with  antipathy  against  the  father 
and  wishes  for  his  removal,  the  greatest  influence  on  the  psycho- 
sexual  development  of  the  patient  was  exerted  by  the  birth  of  a 
sister  when  he  was  three  and  a  half  years  old.  This  event  had 
intensified  his  relations  to  the  parents,  placed  insoluble  problems 
in  his  thoughts  and  the  observation  of  the  nursing  of  the  new- 
born child  revived  the  memory  traces  of  his  own  earliest  pleasur- 
able experiences.  This  influence  is  also  a  typical  one;  in  an 
unexpectedly  large  number  of  life-  and  clinical  histories,  one 
must  consider  this  flaming  up  of  sexual  pleasure  and  curiosity  which 
is  connected  with  the  birth  of  the  next  child  as  the  starting  point 
of  the  understanding.  The  desire  for  knowledge  in  children  does 
not  in  general  awaken  spontaneously  but  under  the  instigation  of 
the  instinct  of  jealousy,  when  at  about  the  end  of  the  second  year 
they  are  met  by  the  arrival  of  a  new  child.  The  justly  feared 
ending  of  the  parental  care  has  an  awakening  influence  on  the 
emotional  life  of  the  child  and  stimulates  his  powers  of  thought.^" 
Under  the  excitation  of  these  emotions  and  troubles,  the  child 
comes  into  contact  with  the  first  great  problem  of  life  and  raises 
the  question  whence  come  the  children,  which  is  usually  couched 
in  the  form:  whence  comes  this  particular  disturbing  child.  If 
the  child,  after  his  unavailing  and  unsatisfactory  investigation, 
turns  to  adults  for  information,  he  receives  either  no  answer  or 
no  sufficient  answer  or  a  rebuke  for  his  unseemly  curiosity  or  he 
will  be  put  off  with  the  mythologically^^  important  information 
that  the  stork  brings  the  children  out  of  the  water.  As  a  rule, 
the  children  give  this  stork  fable  no  credence,  since  the  pregnancy 
of  the  mother  seldom  escapes  their  sharp  observation.  On  the 
contrary,  they  build  false  theories'^  of  the  generation  and  birth  of 

*"  Concerning  the  expression  of  this  complex  in  the  dream,  compare 
Chapter  V. 

"The  elder  child  often  expresses  his  enmity  against  the  new  arrival 
quite  openly. 

"See  Rank,  "Der  Mythus  von  der  Geburt  des  Helden"  (Schriften 
z.  angewandten  Seelenkunde,  Part  5,  F.  Deuticke,  Vienna  and  Leipzic, 
1909). 

"Compare  Freud:  "Uber  infantile  Sexualtheorien,"  Lit.  No.  32. 


48  freud's  theory  of  the  neuroses 

this  child  which  plainly  grew  in  the  body  of  the  mother.  Ignor- 
ance of  the  female  genitals  enables  a  boy  to  form  a  theory  whereby 
the  fetus  is  expelled  as  an  excrement  from  the  anus  (cloacal- 
theory)  ;  others  suppose  it  comes  out  through  the  navel,  to  which 
they  can  assign  no  other  function.  These  theories  naturally  allow 
the  possibility,  for  they  overlook  the  peculiarities  of  the  female 
genitals,  of  both  sexes  bearing  children,  which  idea  really  plays  a 
great  role  in  childish  phantasy-life.  In  general,  the  still  incom- 
plete recognition  of  or  disbelief  in  two  different  sexual  appa- 
ratuses furnishes  the  child  a  weighty  problem  for  childish  thinking 
and  investigation  and  is  solved  at  first  by  the  assumption  that  the 
female  sex  possess  a  penis.  The  grievous  later  results  of  this 
sexual  theory  have  already  been  mentioned  under  homosexuality. 
To-  this  misunderstanding  concerning  the  external  genitals  is 
joined  a  comprehensive  generation  phantasy,  for  example,  the 
maiden's  phantasy  that  generation  is  accomplished  by  a  mere  kiss. 
The  children  also  often  think  of  the  condition  of  wedlock  in  a 
childish  naive  manner  as  a  pleasure-giving  affair  which  pays  little 
attention  to  shame  and  disgust,  most  frequently  in  the  form  that 
the  man  and  woman  unceremoniously  urinate  before  each  other 
or  show  their  posterior  parts.  Exceedingly  often,  the  children 
arrive  at  a  sadistic  conception  of  coitus  and  the  boys  usually  con- 
sider it  a  row  to  which  the  overhearing  of  the  noisy  accomplish- 
ment of  the  act  by  adults,  mostly  the  parents,  with  its  loud  breath- 
ing, misleads  them.  It  must  be  asserted  that  all  these  childish 
theories  are  of  still  greater  value  within  the  neuroses  themselves 
and  exert  a  determining  influence  on  the  formation  of  the 
symptoms. 

Thus,  the  content  of  the  child's  psycho-sexuality  consists  in 
the  autoerotic  activity  of  the  predominating  sexual  components, 
in  traces  of  love  of  an  object  and  in  the  formation  of  that  complex 
which  Freud  has  called  the  nuclear-complex  of  the  neuroses  which 
embraces  the  first  affectionate  as  well  as  hostile  emotions  toward 
the  parents''  and  brothers  and  sisters.    From  the  uniformity  of 

"The  way  in  which  the  persons  in  authority  in  the  family  serve  as 
models  for  the  whole  character  development  and  determination  of  the  fate 
of  healthy  as  well  as  neurotic  individuals  can  not  be  discussed  in  detail 
here.  Reference  can  only  be  made  to  the  important  works  of  Jung,  "  Die 
Bedeutung  des  Vaters  fur  das  Schicksal  des  Einzelnen,"  and  Abraham, 
"  Die  Stellung  der  Verwandtenehe  in  der  Psychologie  der  Neurosen " 
(both  in  Jahrhuch,  I,  1909). 


THE   SEXUAL   INSTINCT  49 

this  content  and  the  constancy  of  the  influences  which  later  modify 
it,  the  statement  may  be  made  that  in  general  the  same  phantasies 
concerning  childhood  are  always  formed.  Thus,  the  neurotics  are 
not  to  be  sharply  differentiated  from  the  normal  and  especially  in 
childhood  are  not  always  to  be  distinguished  from  those  who  re- 
main healthy.  On  the  contrary,  it  is  one  of  the  most  valuable 
results  of  psycho-analytic  investigations  that  the  neuroses  are 
shown  to  have  no  special  characteristic  mental  content  peculiar  to 
themselves,  but  that  the  neurotics,  as  Jung  expresses  it,  are  inca- 
pacitated by  the  same  complexes  with  which  the  healthy  struggle. 
The  difference  is  that  the  healthy  know  how  to  control  these  com- 
plexes without  gross  visible  injuries  while  for  the  neurotics,  the 
suppression  of  these  complexes  is  accomplished  only  at  the  price 
of  costly  substitute  structures,  thus  practically  failing. 

In  still  another  respect  was  the  case  of  that  five-year-old 
patient  interesting.  Namely,  he  showed  in  all  distinctness  what 
Freud  had  then  found  and  announced  in  a  case  of  obsessional 
neurosis,"  that  a  completely  formed  psychoneurosis  can  be  met 
with  at  an  early  age,  about  five  or  six  years.  The  neurosis  of  the 
little  fellow  showed  itself  as  an  anxiety-hysteria  of  the  kind  prop- 
erly, classified  as  a  phobia.  These  anxiety-hysterias  are,  according 
to  Freud's  experience,  not  only  the  most  frequent  of  all  psycho- 
neurotic maladies  in  general,  but  also  the  first  to  appear  in  life, 
indeed  the  neuroses  of  childhood.  Unfortunately,  the  finer 
mechanism  of  this  important  malady  is  still  insufficiently  studied. 
Doubtless  now  that  attention  has  once  been  called  to  the  neuroses 
of  children,  the  publication  of  similar  cases  will  follow'"  which 
will  confirm  the  former  results  and  lead  to  a  deeper  understand- 
ing of  this  so  important  and  interesting  pathological  manifestation. 

"Lit  No,  36. 

*  Compare  Jung,  "  Uber  Konflicte  der  kindlichen  Seele,"  Jahrb.,  II,  I, 
1910. 


CHAPTER  IV 

THE   UNCONSCIOUS 

Consciousness  and  the  Unconscious.  Common  Meaning  of  Uncon- 
scious. Hypnosis  and  Double-Consciousness.  The  Unconscious  in  Hys- 
teria. Resistance  and  Repression.  Genesis  and  Content  of  the  Real 
Unconscious.  The  Complex.  The  Free  Association.  The  Association 
Experiment.  Determination  of  All  Mental  Processes.  Phenomena  of  the 
Unconscious  in  the  Psychopathology  of  Everyday  Life.  The  Unconscious 
in  Wit  and  Dream  Formation. 

The  basic  presupposition  for  an  intelligent  penetration  into  the 
secrets  of  hysteria  is  the  recognition  of  the  nature  and  activity  of 
unconscious  mental  life.  As  an  obstacle  to  appreciating  this, 
stands  preeminently  the  conception  of  the  prevailing  school- 
psychology  for  which  everything  psychic  is  a  priori  only  conscious, 
hence  the  speaking  of  unconscious  mental  processes  constitutes  an 
absolute  absurdity.**®  The  observations  of  the  psycho-analysts, 
however,  compel  the  recognition  of  the  existence  of  unconscious 
mental  processes.  The  physician  educated  in  psycho-analysis  can 
not  do  otherwise  than  reject  the  dogma  of  the  psychologists  that 
consciousness  is  the  indispensable  characteristic  of  mental  life  and 
hold  fast  to  his  conviction  based  on  impressions  gained  from  his 
observations  on  patients.  The  results  of  psycho-analysis  really 
prove  with  every  certainty  possible  in  the  field  of  psychology  an 
unconscious  of  wide  scope  and  great  intensity.  Right  here  it 
should  be  emphasized  that  this  unconscious,  as  psycho-analysis  has 
revealed  it,  has  nothing  to  do  with  the  term  unconscious  as  em- 
ployed in  ordinary  speech  usage.  This  conventional  "uncon- 
scious "  signifies  as  much  as  "  unintentional,"  "  involuntary  "  or  it 
indicates  psychic  elements  of  which  one  has  not  just  thought, 
which,  however,  are  accessible  to  consciousness  and  by  the  concen- 

""This  brusque  opposition  is  really  only  the  result  of  an  erroneous 
use  of  the  word  "conscious"  for  psychic,  two  terms  whose  meaning  is 
not  identical. 

50 


THE  UNCONSCIOUS  $1 

tration  of  the  attention  can  every  time  be  reproduced.'''^  Uncon- 
scious, in  the  Freudian  sense,  on  the  contrary,  means  something 
which  one  does  not  really  know,  while  one  is  compelled  in  the 
analysis  by  conclusive  inferences  to  recognize  it. 

As  already  mentioned,  it  is  chiefly  the  investigations  on 
neurotics  which  convince  the  analyst  of  the  existence  of  the 
unconscious.  Nevertheless,  there  are  certain  other  phenomena 
closely  related  to  the  neuroses  suited  to  demonstrate  in  a  much 
easier  way  the  activity  of  the  unconscious  mental  forces.  Observ- 
ers must  recognize  that  there  may  be  in  one  and  the  same  indi- 
vidual many  mental  groupings  which  can  remain  fairly  independ- 
ent of  one  another,  knowing  nothing  of  one  another  and  alternately 
splitting  consciousness.  Cases  of  this  kind,  which  are  called 
double  personality  or  multiple  personality,  occasionally  come  to 
observation  in  patients  spontaneously.  If  in  such  a  splitting  of 
personality  the  consciousness  remains  constantly  joined  to  one  of 
the  two  conditions,  then  this  is  called  the  conscious  mental  condi- 
tion, the  one  separated  from  it,  the  unconscious.  In  the  recog- 
nized phenomenon  of  the  so-called  post-hypnotic  suggestion,  in 
which  a  command  given  in  the  hypnotic  state  is  later  obeyed  in 
the  normal  condition,  one  has  an  excellent  picture  of  the  influences 
which  the  conscious  condition  can  experience  from  processes 
unconscious  to  it;  taking  this  as  a  pattern,  one  may  classify  the 
experiences  of  hysteria.  Freud  made  use  of  hypnotism  in  the 
treatment  of  hysteria  only  at  the  beginning  of  his  work  with  the 
neuroses;  since  he  soon  discovered  that  only  a  portion  of  his 
patients  could  be  hypnotized,  he  decided  to  work  with  the  normal 
condition.  iProceeding  from  the  free  associations  of  the  patients, 
he  came,  like  Breuer  in.  his  noted  case  by  hypnoidal  conditions,  to 
the  discovery  that  those  impressions  which  had  been  the  occasion 
of  hysterical  phenomena  had  remained  in  wonderful  freshness  and 
with  their  full  affect-tone  for  a  long  period  of  time  without  the 
patient's  being  cognizant  of  these  as  he  was  of  other  affairs  of  his 
life.  On  the  contrary,  these  events  are  completely  missing  in  the 
memory  of  the  patient  in  his  ordinary  mental  state  or  are  present 
at  most  only  in  outline.  By  the  aid  of  the  Freudian  psycho- 
analytic technique,  it  soon  appeared  that  the  splitting  of  con- 

*'  Compare  Bleuler,  "  Bewusstsein  und  Assoziation."  Diagnostische 
Assoziationsstudien,  ed.  by  Jung,  Vol.  I,  No.  5,  Leipzic,  1906,  J.  A.  Barth. 


52  FREUD  S  THEORY  OF  THE   NEUROSES 

sciousness  which  is  so  frequent  in  the  recognized  classical  cases 
as  double  consciousness  may  appear  in  every  case  of  hysteria  in 
the  form  of  a  mental  dissociation.  Thus  resulted  the  necessity  of 
localizing  somewhere  else  these  ideas  which  were  not  present  in 
consciousness  in  the  customary  figurative  language  employed  in 
the  description  of  mental  processes.  Freud  has,  therefore,  in 
accordance  with  Lipps,"**  accepted  the  name  "  unconscious."  We 
speak  here  only  of  the  narrower  meaning  of  unconscious,  as  we 
might  say  the  Freudian  unconscious  or  the  unconscious  of  the 
neurosis.  The  meaning  of  the  same  can  only  become  clear  when 
one  has  recognized  in  what  way  the  sum  of  its  content  was  sepa- 
rated from  the  conscious  mental  processes.  The  patient  betrays 
these  pathogenic  unconscious  mental  impulses  only  under  great 
resistance ;  a  force  prevents  their  becoming  conscious  and  compels 
them  to  remain  unconscious.  One  can  only  really  appreciate  the 
existence  of  this  force  when  one  seeks  in  opposition  to  it  to  bring 
the  unconscious  impulses  of  the  patient  into  consciousness.  On 
this  idea  of  "resistance"  (Widerstand)  Freud  has  founded  his 
conception  of  the  mental  processes  of  hysteria.  The  same  forces 
which  to-day  oppose  as  resistance  the  making  conscious  of  the 
unconscious,  purposely  forgotten,  must  at  one  time  have  accom- 
plished this  forgetting  and  forced  the  offending  pathogenic  experi- 
ence out  of  consciousness.  Freud  named  this  process,  which  he 
supposed  dynamic,  repression  (Verdrangung),  and  considered  it 
as  demonstrated  by  the  undeniable  existence  of  the  resistance 
(Widerstand)."'  The  repression  came  about  by  a  psychic  trau- 
matic experience  of  special  intensity  and  entire  disagreement  with 
the  mental  character  of  the  individual — or,  as  appeared  later,  even 
a  similarly  established  wish  (instinct)  impulse — becoming  engaged 
in  a  kind  of  struggle  for  existence  with  the  ethical  and  esthetic 
attributes  of  the  personality  and  being  thrust  out  of  the  con- 
scious mental  structure  as  you  might  say  by  an  act  of  the  will."" 

"  "  Der  Begriflf  des  Unbewussten  in  der  Psychologic."  Article  at  3d 
International  Congress  for  Psychology,  Munich,  1897. 

"Compare  Freud,  "tJber  Psychoanlyse,"  Lit.  No.  37. 

*  A  similar  active  process  probably  lies  at  the  bottom  of  many  appar- 
ently purely  automatic  forgettings.  Freud  rightly  asserts  that  it  is  not 
so  much  the  condition  of  memory  in  the  earliest  childhood  which  needs 
explanation  as  it  is  the  forgetting  of  all  experiences  of  a  time  when  the 
child  is  perfectly  capable  of  remembering.    Compare  in  this  connection 


THE  UNCONSCIOUS  53 

There  had  been  a  short  previous  conflict,  the  end  of  which  was  the 
repression  of  the  unbearable  idea.  In  the  field  of  logic,  something 
like  the  rejection  of  judgment  would  correspond  to  this  process. 
The  acceptance  of  the  unbearable  wish-impulse  or  a  prolonged 
duration  of  the  conflict  would  have  called  forth  a  higher  degree  of 
discomfort;  this  discomfort  would  be  avoided  by  the  repression 
which  acts  as  a  kind  of  protective  mechanism  of  the  mental  per- 
sonality, as  an  expression  of  the  instinct  of  self-preservation  of 
the  psychic  ego.  The  dissociation  of  the  mind  into  conscious  and 
unconscious  is  explained  not  as  an  inborn  weakness  (Janet)  but 
as  a  dynamic  result  of  the  conflict  of  contending  mental  forces. 
It  may  be  mentioned  here  in  advance  that  the  repression  tending 
to  form  a  neurosis  is  one  which  has  failed  in  so  far  that  the  re- 
pressed wish-impulse  continues  to  exist  in  the  unconscious  and 
waits,  as  it  were,  only  for  the  opportunity  to  become  active  in  the 
form  of  a  distorted  and  unrecognizable  substitute  formation  for 
the  material  repressed  into  the  unconscious :  the  hysterical  symp- 
tom (compare  Chapters  VI  and  VII). 

The  hysterical  repression  has  its  prototype  in  that  previously 
mentioned  organic  repression*^  of  the  first  instinctive  impulses  in 
the  child  which  normally  brings  to  a  close  the  earliest  period  of 
polymorphous-perverse  sexual  activity.  In  this  there  occurs  the 
submersion  into  the  unconscious  not  only  of  individual  experi- 
ences but  of  a  whole  period  of  development.  The  continuation  of 
certain  instinctive  impulses  which  were  originally  accompanied  by 
pleasure  is  brought  by  the  necessary  subordination  to  cultural 
requirements  into  opposition  to  the  goal  ideas  of  the  secondary 
thought  processes  and  now  causes  discomfort  or  pain  instead  of 
pleasure.  Just  this  change  of  affect  constitutes  the  essence  of 
repression.'^  The  material  in  repressed  instincts,  sexual  activities, 
wish-impulses  and  erotic  phantasies  forms  the  foundation,  as  you 

what  has  been  said  on  infantile  amnesia  and  cover-memories.  On  the 
purpose  of  forgetting  in  general,  compare  Freud's  paper  on  the  psychic 
mechanism  of  forgetting  (Lit.  No.  12),  where  he  shows  that  a  part  of 
forgetting  occurs  automatically  but  that  frequently  automatism  and  tend- 
ency (or  purpose)  work  together. 

*An  explanation  of  the  relation  of  this  organic  repression  to  the 
psychological  repression  is  still  lacking. 

*■  More  recent  treatment  of  this  is  found  in  Freud's  "  Traumdeutung," 
2d  ed.,  page  375,  also  Brill's  translation. 


54  freud's  theory  of  the  neuroses 

might  say  the  oldest  and  deepest  layers  in  the  structure,  of  the 
unconscious.  A  second  part  of  the  repressed  material  comes  from 
repressions  in  later  life.  This  repression  of  later  years  comes  about 
through  the  attraction  of  the  old  nucleus  of  the  unconscious, 
while  from  the  other  side  the  repelling  forces  of  consciousness 
again  seek  to  reject  this  definite  material.  These  forces  acting 
from  both  sides  aid  the  act  of  repression  which  when  successful 
is  a  normal  psychological  process.  Through  the  domination  of  the 
unconscious  it  can,  however,  easily  fail;  although  for  the  indi- 
vidual the  repression  succeeds  here  also  since  the  repressed 
material  now  expresses  its  pathogenic  activity  from  the  un- 
conscious. 

That  sum  of  primary  instinctive  impulses  which  are  killed  by 
the  original  repression,  the  real  unconscious  in  the  Freudian  sense, 
which  furnish  the  stream  both  of  the  neurosis  and  the  dream,  is  to 
be  distinctly  differentiated  from  that  popular  "  unconscious  "  men- 
tioned in  the  beginning,  the  combination  of  automatic,  half- 
forgotten,  unintentional  mental  processes.  The  psycho-analytic 
"  unconscious,"  on  the  contrary,  contains  nothing  except  repressed 
instinctive  impulses  in  the  widest  sense  of  the  word,  as  well  as 
those  psychic  formations  which  appear  as  offspring  of  these 
repressed  impulses.  Thus,  the  nucleus  of  this  contains  the  sup- 
pressed component  instincts  in  so  far  as  they  were  overcome  and 
discarded  in  childhood.  The  sexual  disinclination  of  the  hyster- 
ically disposed  individual  causes  all  later  sexual  and  erotic  experi- 
ences to  sink  into  the  unconscious  and  join  the  early  originally 
repressed  material.  The  fundamental  characteristic  of  the  uncon- 
scious is  thus  its  sexual  character,  sexual  taken  in  its  broadest 
sense.  Only  one  who  has  completely  comprehended  the  theory  of 
the  neuroses  is  capable  of  understanding  the  whole  life  power  and 
indestructibility  of  the  unconscious.  The  force  of  this  is  shown 
most  clearly  in  the  eternally  recurring  dreams  and  pathologically 
in  the  lasting  productivity  of  the  neurosis.  The  whole  content  of 
the  unconscious  is,  since  it  is  indestructible,  reproducible  in  full 
vividness  under  appropriate  conditions  (psycho-analysis)  ;  in  fact, 
some  prehistoric  event  of  early  childhood,  long  gone  from  con- 
scious thought,  occasionally  appears  so  unchanged  and  undimin- 
ished in  intensity  that  one  must  characterize  it  as  eternal.    The 


THE   UNCONSCIOUS  55 

task  of  psycho-analysis  is  to  find  the  entrance  to  the  unconscious, 
which  is  also  the  only  way  to  make  conscious  the  unconscious. 

The  difficulty  of  representing  what  is  included  under  the  term 
"  unconscious  "  is  especially  conspicuous  in  the  fact  that  when  we 
speak  of  the  unconscious  of  a  patient,  we  understand  other  things 
besides  the  infantile  unconscious.  In  reality,  the  later  repressed 
psycho-sexual  material,  as  one  encounters  it  in  the  patient,  is  not 
to  be  sharply  distinguished  from  the  infantile  unconscious  mate- 
rial. The  more  remote  descendants  of  the  original  repressed 
impulses  may  no  longer  lie  at  the  bottom  of  the  mass  of  repressed 
material  and  can  often  crop  up  suddenly  in  consciousness.  These 
descendants  constitute  what  might  be  called  flitting  transitions 
from  conscious  to  unconscious  and  would  be  about  the  material 
which  Freud  calls  "  fore-conscious,"  something  which  the  patient 
either  knows  or  wishes  to  know  only  momentarily,  which  with  a 
little  effort,  however,  can  be  brought  to  memory.  It  has  proved 
expedient  to  call  such  groups  of  related  elementary  ideas  possessed 
of  an  affect,  complexes,  following  the  example  of  the  Zurich 
school  (Bleuler,  Jung  and  others).  A  definite  complex  is  in 
every  case  the  occasion  and  content  of  the  neurosis;  it  is  the 
ruling  power  in  the  diseased  mind  and  from  whatever  point  one 
examines  the  patient,  he  comes  upon  derivatives  which  have  be- 
come conscious,  the  conscious  substitute  ideas  of  the  repressed 
complex,  hence  regularly  upon  the  repressed  material,  since  he  is 
controlled  by  the  goal  idea- of  the  treatment  that  the  apparently 
most  innocent  and  arbitrary  thing  reported  has  some  relation  to 
the  pathological  condition.  Proceeding  from  this  presupposition, 
the  analyst  has  merely  to  pay  attention  to  the  free  associations  of 
the  patient  coming  as  it  were  from  the  psychic  surface  to  reach 
the  repressed  pathogenic  complex. 

If  it  seems  to  a  critic  arbitrary  to  consider  the  results  obtained 
from  such  unguided  associations  as  at  all  valuable,  attention  must 
be  emphatically  called  to  the  empirically  discovered  phenomenon 
which  is  of  fundamental  importance  for  the  whole  psycho-analytic 
technique,  namely,  that  there  is  no  accidental  course  of  association, 
that  there  are  no  "  free  "  associations,  that  in  general,  in  mental 
life,  as  elsewhere  in  nature,  there  is  nothing  accidental,  arbitrary, 
not  related  to  a  cause,  but  that  every  thought,  every  association, 
every  mental  occurrence  stands  in  relation  to  its  cause,  thus  is 


56  freud's  theory  of  the  neuroses 

determined,  or  more  exactly,  as  the  dream  investigation  shows,  is 
determined  from  several  sides,  thus  is  over-determined.  This 
causal  connection  science  has  never  denied;  Freud's  service  con- 
sists in  having  confirmed  it  by  psycho-analysis.  The  Zurich  school 
later  furnished*^  experimental  proof  of  this  truth  discovered  by 
Freud,  in  the  association  experiments.  The  association  experi- 
ment inaugurated  by  the  Wundt  school  for  formal  experimental 
psychological  investigations,  which  consists  in  calling  out  to  the 
person  being  examined  test  words  and  registering  his  involun- 
tary answers  (reaction  words),  was  elaborated  by  the  Swiss 
school  (Jung  and  others)  in  manner  of  application  and  utilized  in 
the  sense  of  the  psycho-analytic  investigations,  so  that  now  both 
meaning  and  content  of  the  reactions  are  considered  in  relation 
to  the  test  word  and  to  each  other.  From  this  resulted,  besides 
other  interesting  details,  the  fact  that  all  reaction  words  which  the 
person  being  tested  gives  to  happily  chosen  test  words  stand  in  a 
close  relation  to  one  another  and  belong,  especially  in  neurotics, 
to  the  prevailing  thought  and  emotional  complex.  This  complex 
manifests  itself  by  quite  definite  tokens,  while  the  reactions  dis- 
close it  by  the  following  peculiarities :  lengthened  reaction  times, 
false  reactions,  disturbances  of  reproduction  in  the  repetition  of 
the  experiment,  accompanying  motor  phenomena,  apparent  con- 
tradiction, incoherence  between  test  word  and  reaction,  etc. 
These  disturbances  which  the  complex  causes  in  the  association 
experiment  are  nothing  else  than  the  Freudian  "  resistances  "  of 
the  psycho-analysis."*  It  is  even  possible  to  carry  out  in  this 
field  a  physical  control  by  the  combination  of  the  association 
experiment  with  a  mensuration  of  the  fluctuation  of  an  electric 
current  corresponding  to  the  affect  shown.'' 

The  association  experiment  has  thus  confirmed  the  existence 
of  the  unconscious,  the  activity  of  the  complex,  the  specific  con- 

"*  Compare  "  Diagnostische  Assoziationsstudien,"  ed.  by  Jung,  Vol.  I, 
1906,  and  Vol.  II,  1910.  Jung  gives  a  comprehensive  survey  of  the  results 
of  the  association  investigation  in  the  Apr.  number  of  Amer.  Journal  of 
Psychology,  1910, 

•*  Compare  Jung,  "  Assoziation,  Traum  und  hyst.  Symptom."  Diag. 
Assoziationsstudien,  Vol.  II,  No.  8,  1910. 

•  Compare  L.  Binswanger, "  t)ber  das  Verhalten  des  psychogalvanischen 
Phanomens  beim  Assoziationsexperiment."  Diag.  Assoz.  Stud.,  Vol.  II, 
No.  II. 


THE   UNCONSCIOUS  57 

tent  of  the  etiological  complex  in  the  neuroses  and  likewise  brings 
experimental  proof  for  the  determinism  of  the  apparently  free 
associations  which  had  been  previously  asserted  by  Freud.  This 
comprehensive  and  demonstrable  determinism  in  all  mental  occur- 
rences is  one  of  the  most  important  basic  principles  of  the  Freud- 
ian psychology.  It  seems  conceivable  that  there  may  be  an  uni- 
versal human,  as  you  might  say  normal,  resistance  against  this 
limitation  of  free  will  which  may  lead  to  a  resistance  against  the 
whole  Freudian  theory. 

The  psycho-analytic  investigations  aided  by  the  association 
experiment  have  shown  with  absolute  certainty  that  in  mental 
phenomena  there  is  nothing  little,  nothing  arbitrary,  nothing  acci- 
dental. In  his  book  "  Zur  Psychopathologie  des  Alltagslebens  "°' 
( Psychopathology  of  Everyday  Life)  Freud  has  turned  his  in- 
vestigations in  this  direction,  namely,  to  certain  mistakes,  such  as 
forgetting,  errors  of  speech,  writing  and  action  and  the  like,  and 
could  point  out  that  these  insufficiencies  of  our  mental  perform- 
ances as  well  as  certain  apparently  aimless  performances  (symp- 
tomatic acts)  are  regularly  well  motivated  and  determined  by 
motives  unknown  to  consciousness;  this  is  corroborated  when 
one  subjects  these  unjustly  neglected  minor  affairs  to  a  pene- 
trating psychological  consideration.  The  reason  that  the  motives 
for  such  unintentional  acts  are  hidden  in  the  unconscious  and  can 
only  be  revealed  by  psycho-analysis  is  to  be  sought  in  the  fact  that 
these  phenomena  go  back  to  motives  of  which  consciousness  will 
know  nothing,  hence  were  crowded  into  the  unconscious,  without, 
however,  having  been  deprived  of  every  possibility  of  expressing 
themselves.  These  mistakes,  in  which  an  omission  has  the  same 
value  as  an  error  of  commission,  are  thus  the  disguised  expres- 
sion of  a  mental  impulse  which  has  remained  unconscious  and  thus 
has  a  meaning  that  appears  only  in  a  kind  of  indirect  representa- 
tion. In  similar  manner,  Freud  could  regularly  point  out  behind 
the  wit^'  which  has  a  purpose,  thought  processes  which  make  use 
of  this  characteristic  method  of  expression  in  order  to  half  con- 
ceal, half  reveal  impulses  remaining  unconscious. 

The  most  imposing  evidence  and  far-reaching  explanations  of 
the  unconscious  psychic  processes  in  man  are  afforded  by  the 

-Lit.  No.  i6. 

*  "  Der  Witz  und  seine  Beziehung  zum  Unbewussten,"  Lit  No.  19. 


58  freud's  theory  of  the  neuroses 

penetrating  study  of  the  dream  in  the  art  of  dream  interpretation 
elaborated  by  Freud.  The  scientific  dream  interpretation  inaugu- 
rated by  the  help  of  psycho-analytic  methods  produces  the  proof 
of  the  unexpected  fulness  of  unconscious  activity  and  thought 
formation  in  the  mind  and  shows  that  all  mental  processes  both 
of  simplest  and  most  complicated  character  can  go  on  uncon- 
sciously. Everything  conscious  has  an  unconscious  preliminary- 
stage;  the  unconscious  mental  circle  appears  as  the  greater  one 
which  includes  the  lesser  one  of  consciousness  (Lipps). 

The  speech  of  the  unconscious  is  rich  in  means  of  expression 
which  are  full  of  oddities  for  one  who  becomes  acquainted  with 
them  for  the  first  time :  dream,  symptomatic  act,  wit,  the  peculiar 
manners  of  reaction  in  the  association  experiment,  the  enigmatical 
neurotic  symptoms  and  finally  the  seemingly  free  association 
which  seems  the  more  harmless  and  distorted  the  farther  it  is 
separated  from  the  repressed  complex.  All  these  phenomena  owe 
their  complication  or  difficulty  of  interpretation  to  the  circum- 
stance that  the  unconscious  can  express  itself  only  in  a  form 
which  has  been  censored  by  consciousness.  Consciousness  allows 
no  direct  representation  of  the  scandalous  and  since  the  indirect 
(censored)  representation  contains  so  much  that  is  novel,  para- 
doxical and  curious  for  the  uninitiated,  so  an  intelligible  resist- 
ance is  directed  against  psycho-analysis  which  unmasks  this  secret 
speech.  The  resistance  against  this  strange  method  of  expression 
of  the  unconscious  gladly  clothes  itself  in  an  intellectual  denial  of 
the  whole  Freudian  theory  and  is  to  be  overcome  only  by  repeated 
experiences  which  convince  one  of  the  entire  regularity  of  the 
speech  of  the  unconscious.  Whoever  brings  the  good  intention  to 
take  this  explanation  of  his  resistance  succeeds  best  in  the  study 
of  his  own  dreams  according  to  Freud's  directions;  he  can  thus 
convince  himself  of  the  presence  and  power  of  his  unconscious 
mental  impulses  and  thus  succeeds  in  the  best  way  in  becoming  a 
psycho-analyst.  Dreams  are  really  the  first  member  in  the  series 
of  abnormal  psychic  structures,  the  other  members  of  which,  the 
hysterical  phobia,  the  obsessional  and  delusional  idea,  occupy  the 
physician  for  practical  reasons.  Freud  may  thus  rightly  insist 
that  he  who  does  not  know  how  to  elucidate  the  origin  of  the 
dream  picture  will  work  in  vain  for  a  comprehension  of  the  obses- 
sional and  delusional  idea.    Our  nocturnal  dream  products  are 


THE   UNCONSCIOUS  59 

indeed  compatible  with  full  health  of  waking  life  but  have  also 
the  greatest  external  similarity  and  internal  relationship  to  the 
creations  of  the  insanities.  Thus  the  dream  stands  in  the  center 
not  only  of  the  Freudian  theory  but  also  of  the  psycho-analytic 
technique,  and  because  of  its  fundamental  importance  will  be 
treated  in  the  next  chapter  in  detail  as  an  introduction  to  the 
theory  of  the  psychoneuroses  and  analytic  therapy. 


CHAPTER  V 


THE  DREAM 


Chief  Characteristics  of  the  Dream:  Wish  Fulfillment,  Sexual  Erotic 
Content.  Dream  Sources.  Dream  Distortion  (Manifest  and  Latent  Con- 
tent). The  Dream  Making.  Interpretation  Technique:  (o)  by  Symbo- 
lism; (b)  by  Associations.    Technical  Rules.    Typical  Dreams. 

Freud  came  to  take  up  the  scientific  study  of  dreams  in  an 
empirical  way  since  neurotics  who  were  undergoing  psycho- 
analytic treatment  often  related  to  him  spontaneously  dreams 
which  were  still  intensively  occupying  them  by  day.  A  closer 
examination  of  the  content  of  these  dreams  revealed  the  fact 
that  they  stood  in  close  relation  to  the  agencies  which  caused  the 
malady  and  that  here  again  the  infantile  sexual  roots  were  exhib- 
ited. In  this  way,  Freud  came  to  create  the  technique  for  the 
interpretation  of  dreams  corresponding  in  its  main  features  to  the 
psycho-analytic  method  of  investigation ;  this  has  become  an  indis- 
pensable part  of  the  psycho-analytic  therapy.  The  unconscious 
which  lies  at  the  bottom  of  the  neurosis  betrays  itself  in  the 
dream,  not  undisguised  to  be  sure,  but  in  decipherable  manner, 
so  that  the  dream  becomes  the  chief  entrance,  you  might  say  the 
"  via  regia  "  to  the  patient's  unconscious.  How  great  significance 
the  solution  of  the  ancient  dream  problem  has  for  psychology 
cannot  here  be  gone  into  in  detail ;  our  interest  here  is  only  in  the 
practical  value  of  dream  interpretation  for  the  treatment  of  the 
neuroses.  All  mechanisms  which  enter  into  the  origin  of  neurotic 
symptoms  have  also  a  share  in  the  formation  of  the  dream.  The 
incomprehensibility  of  the  dream  is  therefore  the  same  as  that 
of  neurotic  symptoms ;  they  are  both  the  substitute  expression  for 
the  sexual  material  which  has  become  unconscious  through  repres- 
sion. In  both  cases,  we  have  to  deal  with  incompletely  repressed 
infantile  sexual  impulses  and  later  sexual  material  which  has 
joined  these.  Besides  the  infantile  and  sexual  matters  which  fur- 
nish the  real  dream  sources,  there  also  come  into  consideration  as 
such  sources,  the  unnoticed  daily  happenings   ("  Tagesreste ") 

60 


THE  DREAM  6 1 

with  their  numerous  apparently  indifferent  details;  to  superficial 
observation,  these  frequently  seem  to  control  the  dream  picture. 
Somatic  stimuli  and  external  irritations  should  not  be  overesti- 
mated as  dream  instigators ;  they  can  indeed  instigate  the  dream, 
but  always  serve  merely  to  clothe  the  unconscious  wishes  like  all 
other  recent  material. 

After  profound  investigation  of  his  own  dreams  and  those  of 
neurotics,  Freud,  in  the  year  1900,  could  give  in  his  "Traum- 
deutung"  a  detailed  account  of  the  characteristics  of  the  dream. 
The  most  important  discovery  was  that  the  dream  regularly  rep- 
resents a  wish-fulfillment,  that  is,  it  brings  to  representation  in 
dramatic  form  an  unconscious  wish  of  the  dreamer  represented 
as  fulfilled.  In  this  an  infantile  wish  is  readily  combined  with 
an  actual  one.  The  wish  characteristic  may  be  easily  recognized 
in  isolated  dreams  if  it  is  not  apparent  in  the  majority  of  the 
dreams  of  adults.  On  the  contrary,  the  dreams  of  healthy  chil- 
dren show  as  fulfilled  their  naive  simple  wishes  which  have  been 
active  by  day  and  remained  unfulfilled.  Numerous  other  dreams, 
especially  such  as  anxiety  and  fear  dreams,  seem  at  first  to  be  an 
argument  against  the  universal  validity  of  the  wish  theory. 
Naturally  Freud  could  not  escape  this,  but  he  has  pointed  out 
that  the  anxiety  dream  after  being  subjected  to  penetrating  inter- 
pretation likewise  shows  itself  to  be  the  representation  of  a  sup- 
pressed (repressed)  sexual  wish,  the  disguise  of  which  has  failed. 
To  prove  this  position,  Freud  has  undertaken  in  his  work  the 
analysis  of  a  number  of  anxiety-dreams  and  shown  the  sexual 
material  in  the  dream  thoughts.  From  these  it  was  made  evident 
that  the  anxiety  which  we  feel  in  the  dream  is  only  apparently 
explained  by  the  content  of  the  dream ;  it  is  only  attached  to  the 
accompanying  idea  and  arises  from  other  sources.  Thus,  the 
anxiety-dreams  not  only  exhibit  a  new  side  of  the  dream  prob- 
lem but  are  also  important  for  the  comprehension  of  neurotic 
anxiety  in  general.  The  anxiety-dream  belongs,  therefore,  to  the 
anxiety  problem  and  will  be  further  discussed  in  the  diapter  on 
hysteria. 

One  must  not  represent  the  interpretation  and  arrangement  of 
the  dream  in  the  mental  life  of  the  individual  as  too  simple. 
What  we  remember  in  the  morning  ("the  manifest  content")  is 
mostly  a  highly  phantastic,  sometimes  paradoxical,  thought  pic- 


62  freud's  theory  of  the  neuroses 

ture  which  even  where  it  seems  logically  composed  does  not  betray 
the  real  meaning  of  the  dream  ("the  latent  content").  Only  the 
interpretation  work  which  will  be  discussed  in  detail  later  can 
show  the  "latent"  thought  content  hidden  behind  this  manifest 
dream  content,  that  is  to  say,  the  particular  unconscious  wish. 
One  must  not  be  led  astray  by  the  fact  that  the  dream  is  joined 
in  many  ways  to  the  events  and  impressions  of  the  preceding  day 
or  evening.  These  connections  are  only  superficial  and  have  only 
loose,  unimportant  relations  to  the  real  dream-forming  complexes. 
The  true  foundation  of  the  dream  is  furnished  by  the  wishes  of 
childhood  which  have  become  unattainable  and  stored  away  in 
the  unconscious ;  these  have  normally  disappeared  into  the  uncon- 
scious because  of  psycho-sexual  development.  The  particular 
dream-forming  wishes  which  are  fulfilled  in  the  dream  and  can 
be  disclosed  only  by  the  interpretation  work  show,  in  contrast  to 
the  manifest  content,  a  logical  and  intelligible  as  well  as  affectively 
well-motived  train  of  thought  which  is  organically  connected 
with  the  rest  of  the  mental  life.  The  manifest  dream  remembered 
in  the  morning,  on  the  contrary,  is  often  without  affect,  discon- 
nected, unintelligible,  as  strange  to  the  waking  consciousness  as 
the  delusions  of  the  insane  are  to  the  normal  consciousness.  Thus 
one  comes  upon  the  fact  that  the  dream  is  the  expression  of  those 
old  instinctive  wishes  later  felt  as  painful  (repressed),  now  re- 
turned to  life  again  distorted  by  a  complicated  mechanism.  Freud 
assumes  that  consciousness  in  the  service  of  the  repressing  activ- 
ity of  the  ego  continues  working  in  the  dream  as  a  kind  of  psychic 
censor,  not  allowing  those  forbidden  impulses  to  pass  in  full  dis- 
tinctness but  only  when  disguised  in  speech  and  form.  By  this 
cultural  limitation  the  appearance  of  painful  emotions  which  would 
accompany  the  becoming  fully  conscious  of  the  unconscious  is 
avoided  as  a  rule  (compare  on  the  contrary  the  failure  of  this 
dream  tendency  in  the  anxiety-dream)  and  undisturbed  peaceful 
sleep  is  protected.  Thus,  the  dream  proves — ^just  the  opposite  of 
the  common  opinion — the  real  protector  of  sleep,  against  which 
the  fact  that  it  does  not  always  accomplish  this  task  (anxiety- 
dreams)  in  no  way  militates.  This  tendency  shows  plainest  in  a 
group  of  dreams  which  have  always  been  cited  in  support  of  the 
common  theory  that  the  dream  pictures  owe  their  origin  merely  to 
certain  physical  irritations.    In  the  sense  of  the  Freudian  concep- 


THE   DREAM  63 

tion,  a  series  of  these  dreams,  the  so-called  satisfaction-dreams, 
afford  the  best  proof  of  two  dream  characteristics  declared  by 
Freud  to  be  universal,  since  these  dreams  represent  a  bodily  need 
which  appears  in  sleep  (for  example  thirst)  as  gratified  and  thus 
serve  to  guard  sleep.  These  dreams,  like  children's  dreams,  also 
plainly  show  the  wish-fulfilling  characteristic. 

It  is  nevertheless  quite  otherwise  with  that  by  far  the  greatest 
group  of  dreams  of  adults,  especially  of  neurotics,  for  the  illumi- 
nation of  which  a  painstaking  and  complicated  interpretation  work 
is  necessary ;  after  this  has  been  done,  however,  these  dreams  also 
show  the  same  characteristics.  Now  arises  the  question,  what  are 
the  mental  processes  which  have  transformed  the  dream  thoughts 
discovered  by  painstaking  interpretation  into  the  dream  form  so 
incomprehensible  to  us  at  first.  From  the  comparison  of  the 
remembered  manifest  content  of  the  dream  with  the  discovered 
latent  content  comes  the  term  "  dream-making "  (Traumarbeit) 
which  has  occasioned  the  dream  distortion  (Traumentstellung). 

If  one  proceeds  to  get  a  closer  view  of  the  many-sided  and 
peculiar  dream-making  process,  one  is  at  once  struck  by  a  phe- 
nomenon already  recognized  externally.  The  dream  thoughts 
discovered  by  analysis  tremendously  exceed  in  extent  the  remem- 
bered dream  content.  This  circumstance  points  to  a  great  conden- 
sation of  the  dream  thoughts.  Each  element  of  the  dream  con- 
tent really  traces  its  source  not  to  a  single  element  of  the  latent 
dream  thoughts  but  to  a  series  of  such  elements;  on  the  other 
hand,  however,  it  is  also  a  rule  that  a  dream  thought  may  be  rep- 
resented by  more  than  one  dream  element  in  the  dream.  Thus, 
the  threads  of  association  do  not  simply  converge  from  dream 
thoughts  to  dream  content  but  criss  cross  and  interweave  promis- 
cuously on  the  way.  In  this  condensation  process,  certain  like- 
nesses which  originally  existed  among  the  dream  thoughts  or  have 
been  elaborated  by  the  dream-making  in  a  very  keen  and  ingenious, 
witty  manner  play  the  greatest  role. 

Besides  the  condensation,  there  is  a  second  process  suited  to 
add  to  our  misunderstanding  of  the  dream  picture  a  strangeness 
concerning  the  mental  value  of  the  same,  while  the  complete  inter- 
pretation shows  us  well-ordered  and  ingenious  trains  of  thought 
which  lie  at  the  bottom  of  the  dream  in  their  proper  mental  accen- 
tuation; almost  always  in  the  dream,  something  of  secondary 


64  Freud's  theory  of  the  neuroses 

importance  and  insignificance  is  exhibited  with  a  disproportionate 
amount  of  affect.  This  displacement  (Verschiebung)  of  the 
mental  values  from  important  to  insignificant  serves  mostly  to 
conceal  the  meaning  of  the  dream  and  to  render  irrecognizable 
the  connection  between  the  dream  content  and  the  dream 
thoughts.®* 

Besides  the  condensation  and  displacement,  the  two  most  im- 
portant and  for  the  dream-making  most  characteristic  processes, 
the  attempt  to  present  the  material  in  dramatic  form  (Riicksicht 
auf  Darstellbarkeit)  drives  the  dream,  at  first  in  verbal  expression, 
to  very  strange  performances  in  order  that  the  dream  thoughts 
may  be  presented  in  visible  form ;  to  this  aim,  manifold  distortions 
and  modifications  must  be  brought  about. 

The  dream  thoughts  which  by  the  attempt  to  present  them  in 
dramatic  form  and  by  the  dream  distortion  practiced  by  the  censor 
have  become  irrecognizable  and  incomprehensible  are  finally  sub- 
jected to  a  final  external  arrangement  which  is  carried  out  more 
or  less  carefully  in  different  dreams  to  give  the  dream  pictures 
which  were  originally  intelligible  but  have  become  meaningless 
through  the  dream-making,  at  least  externally  the  appearance  of 
sense  and  connection.  This  procedure  of  the  dream-making  which 
Freud  has  called  "secondary  elaboration"  ("sekundare  Bear- 
beitung"),  which  really  represents  a  concession  to  conscious 
thinking,  also  serves  on  the  other  hand  to  further  the  aims  of  the 
censor,  since  conscious  attention,  which  in  badly  elaborated  dreams 
is  diverted  by  the  judgment :  "  foolish  "  or  "  dreams  are  nonsense," 
in  dreams  with  well-composed  fagades  is  reassured  by  this  super- 
ficial meaning  whereby  a  penetration  into  the  deeper  meaning  of 
the  dream  is  avoided. 

The  next  most  important  fact  concerning  dreams  after  the 
wish  characteristic  is  the  basic  principle  that  the  majority  of 
dreams  of  adults  deal  with  sexual  material  and  give  expression  to 
erotic  wishes.  It  is  obvious  that  one  can  form  an  opinion  on  this 
only  when  one  considers  not  merely  the  manifest  content  but 

**  Condensation  and  displacement  find  expression  not  only  in  thought- 
making,  but  also  in  the  dramatization  of  details.  Thus,  objects,  words 
and  persons  can  be  made  irrecognizable  by  combination;  a  person  at  first 
apparently  unknown  to  the  dreamer  is  regularly  a  composite  person. 


THE  DREAM  65 

understands  how  to  penetrate  to  the  latent  dream  thoughts.  The 
explanation  of  the  ubiquity  of  sexual  erotic  material  in  dreams  is 
to  be  sought  in  the  fact  that  no  other  instinct  has  undergone  so 
much  suppression  from  childhood  on,  as  the  sexual  instinct  in  its 
numerous  components.  Thus,  the  erotic  wish- fulfillment  forms 
the  essential  content  of  the  dream;  still,  it  has  never  occurred  to 
Freud  to  make  this  characteristic  of  the  dream  exclusive,  as  is 
best  shown  by  his  comprehensive  book  on  dream  interpretation 
where  justice  is  done  to  selfish  and  ambitious  wishes. 

The  assertion  that  the  majority  of  the  dreams  of  adults  betray 
in  their  ultimate  analysis  a  sexual  content  seems  at  first — ^just 
like  the  wish- fulfillment  theory — unproven,  since  the  wording  and 
pictures  of  the  dream,  aside  from  the  exquisite  sexual  (pollution) 
dreams,  seldom  deal  with  sexual  scenes,  lascivious  allusions  and 
the  like  but  are  mostly  thrown  together  in  a  harmless,  often  poet- 
ical manner  from  nature,  family,  society,  travels,  etc.,  forming 
living  pictures  corresponding  to  the  real  family,  vocational  and 
amusement  life.  At  first  it  seems  arbitrary  to  wish  to  read  out 
of  this  boundless  picture  gallery  comprising  the  whole  life  in  all 
its  phases  a  single  definite  tendency  which  would  serve  only  one 
instinct.  Since  we  are  dealing  with  an  instinct  of  which  everyone 
is  more  or  less  ashamed  and  which  he  does  not  like  to  acknowl- 
edge himself  too  much  possessed  by,  it  was  this  part  of  the  dream 
theory  which  aroused  universal  surprise  and  contradiction.  Never- 
theless, Freud  has  proven  that  the  theme  of  sexuality  does  not 
appear  undisguised  in  dreams  but  is  represented  in  a  definite, 
typical,  regularly  found  symbolic  manner  of  expression  analogous 
to  pantomime.®®  To  a  layman,  who  came  across  this  theory  for 
the  first  time,  it  might  seem  grossly  arbitrary  to  consider  quite 
innocent  and  apparently  accidental  pictures,  objects,  persons, 
activities,  plays  on  words,  etc.,  in  sexual  and  shocking  sense.  But 
he  who  has  learned  to  understand  the  speech  of  the  neurosis 
released  from  the  repression  will  be  easily  convinced  that  the 
dream  as  well  as  the  pantomime  of  the  neurosis  can  not  disclose 

**In  a  dream  in  two  parts  of  a  healthy  person,  the  second  part  of 
which — an  undisguised  pollution-dream — disclosed  the  apparently  harm- 
less symbolically  clothed  and  sublimated  introductory  dream  as  grossly 
sexual,  Rank  was  able  to  substantiate  the  fundamental  principles  of  the 
Freudian  dream  theory  as  it  were  by  the  dream  itself.  Compare  "Ein 
Traum  der  sich  selbst  deutet,"  Jahrb.,  II,  2,  1910. 

6 


66  freud's  theory  of  the  neuroses 

its  real  meaning  undisguised.  Where  the  manifest  content  of  the 
dream  is  accidently  harmless,  confused  or  indistinct  (which  is 
frequently  coupled  with  anxiety)  one  should  always  suspect 
behind  it  an  especially  abundant  repression  of  something  valuable. 
It  is  the  censor  which  compels  dreams  to  adopt  the  mystic  lan- 
guage of  symbolism  to  secure  the  possibility  of  dramatization  of 
sexual  material  in  dreams.  If  one  has  convinced  himself  of  the 
wide  use  of  symbolism  for  the  dramatization  of  sexual  material 
in  dreams,  he  must  have  been  struck  by  the  question  whether  or 
not  many  of  these  symbols  appear  like  the  characters  of  stenog- 
raphy with  a  fixed  meaning  for  all  cases.  In  this  connection,  it 
is  to  be  noticed  that  this  symbolism  belongs  not  only  to  dreams 
but  also  to  the  unconscious  folk  ideas  and  is  found  as  completely 
in  folk-lore,  myths,  saga,"*  sayings,  maxims  and  in  the  current  wit 
of  a  people  as  in  dreams.'^^  Among  the  symbols  so  used  are  really 
many  which  regularly  or  almost  regularly  mean  the  same  thing; 
upon  this,  in  greatest  part,  the  general  understanding  and  far- 
reaching  activity  of  these  creations  of  the  folk-mind  depend.'^^ 
Still,  one  must  always  bear  in  mind  the  possibility  that  occasion- 
ally an  element  in  the  dream  content  is  not  to  be  interpreted  sym- 
bolically but  in  its  real  sense;  in  other  cases,  the  dreamer  may 
claim  the  right  to  anything  possible  out  of  special  remembered 
material  as  an  individual  sexual  symbol  which  is  not  generally  so 
employed.  Further,  the  customary  sexual  symbols  are  not  in 
every  case  limited  to  the  one  meaning. 

After  giving  these  limitations  and  precautions,  Freud  intro- 
duces a  series  of  typical  sexual  symbols:  emperor  and  empress 
(king  and  queen)  usually  stand  for  the  parents  of  the  dreamer, 
prince  or  princess  for  the  dreamer  himself.    All  long  objects  such 

''Compare  Riklin,  " Wunscherf iillung  und  SymboHk  im  Marchen." 
Further,  Abraham,  "  Traum  und  Mythus"  and  the  works  cited  there  by 
Kleinpaul  and  others ;  also  Rank,  "  Der  Mythus  von  der  Geburt  des 
Helden."    They  all  appear  in  Schriften  z.  angew.  Seelenkunde. 

"In  regard  to  the  skepticism  which  the  symbolic  interpretation  en- 
counters from  so  many,  it  is  characteristic  that  the  same  men  while 
listening  to  the  cynical  tune  at  the  Kneipe  or  the  cabaret  or  reading  the 
humorous  paper  are  suddenly  sufficiently  disposed  to  understand  sexual 
symbolism ! 

"  Symbolism  was  already  familiar  in  part  to  the  old  authors  (Arte- 
midorus)  and  also  to  the  newer  ones  (Schemer,  Volkelt  and  others). 


THE  DREAM  6/ 

as  canes,  limbs  of  trees,  snakes,  umbrellas  (because  when  put  up 
they  resemble  an  erection!)  indicate  the  penis.  A'  frequent,  not 
readily  understood  symbol  of  the  same  is  the  nail  file  (because  of 
the  rubbing  and  scraping?).  Small  boxes,  band-boxes,  caskets, 
closets,  ovens,  wagons  correspond  to  the  female  body.  Rooms  in 
dreams  are  mostly  ladies'  rooms,  the  representation  of  the  en- 
trances and  exits  will  not  be  misunderstood  in  this  connection. 
The  dream  of  going  through  a  series  of  rooms  is  a  brothel  or 
harem  dream.  Tables,  tables  that  are  set  and  boards  are  likewise 
women  probably  because  of  the  contrast  which  here  preserves  the 
body  arches.  Since  board  and  bed  make  the  marriage,  in  dreams, 
the  first  is  often  placed  for  the  last  and  so  far  as  it  applies,  the 
sexual  idea-complex  is  transported  to  the  eating  complex.  All 
complicated  machines  and  apparatus  in  dreams  are  with  great 
probability  genitals,  in  the  describing  of  which,  dream  symbolism 
shows  itself  as  untiring  as  wit-making.  Landscapes  often  signify 
female  genitals ;  the  locality  "  in  which  one  was  once  before  "  may 
symbolize  the  mother's  genitals.  Children  in  dreams  also  often 
signify  the  genitals  as  men  and  women  are  occasionally  disposed 
to  call  their  genitals  their  "  little  one."  Stekel,  who  has  devoted 
himself  especially  to  tracing  out  dream  symbolism,'^^  continues 
further  that  left  and  right  often  mean  wrong  and  "  right "  or  are 
then  used  in  transferred  sense  for  sensuous  (sinnlich)  and  moral 
(sittlich),  normal  and  abnormal,  male  and  female,  etc.;  further, 
that  death  and  thoughts  of  death  in  dreams  are  often  to  be  taken 
as  repressed  counterparts  for  life  and  riotous  living.  It  is  to  be 
expected  that  the  scientific  proof  for  the  wide  range  and  folk- 
psychological  basis  of  symbolism  will  soon  be  fully  produced  by 
mythologists,  linguists  and  students  of  folk-lore'^*  and  that  thus 
its  paradox  will  be  lost.  He  who  does  not  understand  the  lan- 
guage of  dream  symbolism  will  never  completely  interpret  a  dream 
and  can  never  carry  through  a  completely  successful  psycho- 
analysis.   The  symbolism  is  the  first  and  most  important  tech- 

"  "  Beitrage  zur  Traumdeutung "  (Jahrb.,  I,  page  458)  and  further  in 
the  discussion  of  the  "  Angstzustande."  Interesting  data  on  dream  symbol- 
ism are  also  found  in  Maeder,  "  Essai  d'interpretation  des  quelques  reves  " 
(Archives  de  Psychologie,  1907,  No.  24). 

''*  Compare  "  Anthropophyteia,"  ed.  by  F.  S.  Krauss,  Leipzic,  Deut. 
Ver.  Akgt. 


68  freud's  theory  of  the  neuroses 

nical  aid  to  psycho-analytic  dream  interpretation.  Therefore,  a 
knowledge  of  it  is  indispensable  to  the  psycho-analyst  because  this 
symbolism,  so  widespread  in  the  history  of  races  and  forming  such 
a  sure  postulate  for  those  living  under  the  same  cultural  condi- 
tions, still  in  isolated  cases,  especially  in  neurotics,  may  be  an 
unconscious  one  and  therefore  brings  no  associations  to  the 
dreamer  when  he  relates  his  dream.  It  is  the  task  of  the  analyst 
to  bring  the  same  into  use  and  just  where  an  element,  through  the 
absence  of  associations,  makes  itself  suspicious  as  a  symbol. 
Thorough  familiarity  with  symbolism  enables  the  physician  to 
disclose  the  deepest  strata  of  the  unconscious  dream  thoughts 
with  a  high  degree  of  certainty ;  still,  the  discovery  of  the  recent 
experiences  and  the  dream  thoughts  springing  from  actual  con- 
flicts can  only  be  accomplished  by  the  aid  of  free  associations.  In 
this  way  only  is  it  possible  to  arrange  the  special  dream  in  its 
proper  psychic  connection.  This  particular  kind  of  analysis  brings 
to  light  some  material  which  is  not  unconscious  in  the  strict  sense 
of  the  word  but  may  be  called  fore-conscious  because  it  is  not 
directly  inaccessible  to  consciousness  but  rather  may  be  rendered 
conscious  without  any  especial  difficulty. 

Here,  the  technique  of  dream  interpretation  does  not  proceed 
from  symbolism  but  from  the  particular  associations  and  spon- 
taneous connections  of  the  dreamer,  the  relation  of  which  to  the 
sought-for  thought  complex  may  be  proven  by  the  already  men- 
tioned association  experiment.  If  one  wishes  to  interpret  a  dream 
according  to  the  method  here  described,  it  is  best  to  analyze  the 
dream  elements  separately,  according  to  the  dream  text  noted 
down  from  the  fresh  remembrance  in  the  morning  without  any 
attention  to  its  eventual  external  connection  (secondary  elabora- 
tion). If  one  devotes  himself  now  to  the  free  associations  from 
each  of  these  elements  taken  at  random  out  of  its  context  of 
ideas  and  memories,  then  he  soon  succeeds  in  apprehending  a  lot 
of  ideas  and  memories  which  not  only  possess  an  internal  rela- 
tionship to  the  dream  content  but  also  arrange  themselves  in  a 
connected  and  intelligible  whole.  The  associations,  whether  free 
or  from  test  words,  are  distinguished  in  many  ways  by  a  super- 
ficial connection,  by  clang  association,  plays  on  meanings  of  words, 
temporal  conjunctions,  inner  sense  relations,  in  short  by  all  the 


THE  DREAM  69 

association  ways  which  we  are  accustomed'^''  to  observe  in  wit  and 
puns.  No  connection  is  too  loose,  no  witticism  too  far-fetched  to 
have  formed  the  bridge  from  one  thought  to  another.  The  serious 
and  important  utilization  of  these  associations  becomes  plausible, 
however,  when  one  knows  that  every  time  a  psychic  element  is 
joined  to  another  by  a  shocking  and  superficial  association,  a  cor- 
rect and  deeper  attachment  exists  between  the  two,  which  because 
of  the  underlying  resistance  of  the  censor  must  be  concealed  be- 
hind that  superficial  connection.  The  beginner  who  can  hardly 
make  up  his  mind  to  adopt  this  rule  will  also  not  hear  without 
resistance  that  occasionally  a  part  of  a  dream  only  becomes  intel- 
ligible after  one  has  inverted'^^  individual  elements  either  in  con- 
tent or  temporal  relationship.  The  inversion,  change  to  the  con- 
trary,'^^  is  one  of  the  favorite  means  of  dramatization  in  the  dream- 
making  and  capable  of  manifold  application.  It  serves  first  of  all 
to  furnish  meaning  for  the  wish- fulfillment  in  respect  to  a  defi- 
nite element.  "  Would  that  it  had  been  different "  is  often  the 
best  expression  for  the  relation  of  the  ego  concerning  a  painful 
bit  of  memory.  The  inversion  becomes  very  valuable  in  the  serv- 
ice of  the  censor  since  it  brings  about  a  measure  of  distortion  of 
the  material  being  dramatized  which  immediately  interferes  with 
the  understanding  of  the  dream.  Therefore,  when  a  dream  obsti- 
nately refuses  to  yield  its  meaning  to  interpretation,  one  may 
every  time  venture  to  try  the  inversion  of  the  special  parts  of  its 
manifest  content  and  often  all  becomes  clear.  Besides  the  inver- 
sion of  content,  the  inversion  of  time  is  also  not  to  be  overlooked.'* 
Whoever  wishes  to  take  up  the  scientific  interpretation  of  dreams, 
must  continually  study  the  "  Traumdeutung "  of  Freud's.    Here 

"  That  the  ancients  had  a  knowledge  of  such  mechanisms  which  must 
in  general  be  considered  as  forerunners  of  psychological  dream  inter- 
pretation is  shown  by  the  following  example:  Alexander  while  despairing 
of  the  capture  of  the  city  of  Tyre  which  he  had  besieged  had  his  dream 
of  a  Satyr  dancing  in  triumph  on  a  shield  interpreted  by  the  dream- 
interpreter  as  being  good  fortune  since  o-d  Tvpos  meant  your  Tyre  (Tyros) 
(Artemidorus). 

^'As  a  linguistic  confirmation,  compare  Freud,  "t)ber  den  Gegensinn 
der  Urworte,"  Lit.  No.  40. 

"  Compare  for  example  the  symbolic  dramatization  of  "  secret "  by 
the  presence  of  many  persons  or  the  whole  family, 

"  The  same  technique  serves  many  times  to  conceal  the  meaning  of  the 
hysterical  attack.    Lit.  No.  33. 


70  freud's  theory  of  the  neuroses 

can  be  given  only  some  practical  hints  and  the  indispensable  in- 
structions. For  example,  everything  which  appears  in  the  dream 
at  all  striking,  as  spoken  language,  goes  back  to  real  language  of 
the  dreamer  or  to  speech  which  he  has  heard/*  In  this  regard, 
the  analysis  reveals  that  the  dream  combines  most  arbitrarily  mere 
fragments  of  these  real  speeches.  Another  means  of  the  censor 
is  the  forgetting  of  the  dream  which  is  in  this  manner  withdrawn 
from  analysis.  At  the  beginning  of  the  treatment,  this  happens 
often  so  completely  that  the  patient  in  general  brings  no  dreams 
and  also  asserts  that  he  dreamed  none.*"  In  weakened  form,  this 
tendency  of  the  censor  is  shown  in  the  forgetting  of  a  part  of  a 
dream,  which,  if  it  is  afterwards  remembered,  must  be  appraised 
very  highly;  it  is  easy  to  understand  that  for  just  this  reason  it 
would  be  kept  from  the  work  of  interpretation  as  long  as  possible. 
A  kind  of  failed  forgetting  is  shown  in  isolated  parts  of  a  dream 
being  characterized  as  "  confused  or  unimportant."  These  parts 
are  also  especially  important  and  will  usually  conceal  something 
strikingly  surprising  and  shocking  from  the  unconscious.  For 
interpretation  work,  it  is  important  to  remember  that  dreams  of 
the  same  night  or  now  and  then  even  of  a  series  of  nights  have  a 
close  relation  as  to  content  and  especially  that  the  dreams  of  a 
single  night  are  always  to  be  considered  as  a  whole. 

In  dream  interpretation,  it  is  a  most  difficult  thing  to  con- 
vince a  beginner  that  his  task  is  not  completely  performed  when 
he  has  a  full  interpretation  of  the  dream  in  his  hands,  one  which 
is  intelligible,  connected  and  gives  information  concerning  all  the 
elements  of  the  dream  content.  There  may  be  possible  another 
one  besides,  a  further  interpretation  (over-interpretation)  of  the 
same  dream.  The  question  whether  every  dream  can  be  inter- 
preted is  for  practical  purposes  to  be  answered  in  the  negative. 
It  should  not  be  forgotten  that  in  dream  interpretation  one  has 
against  one  the  mental  forces  which  cause  the  distortion  of  the 
dream.  Thus  it  is  a  question  of  relative  strength  whether  one  can 
become  master  of  the  inner  resistances.    Part  way  this  is  always 

"  Thus  far,  the  only  exception  to  this  empiric  rule  is  in  certain  dreams 
of  the  obsessed  which  may  bring  the  particular  text  of  the  obsessional 
command  in  the  form  of  spoken  language,  which  text  is  known  to  them 
in  waking  hours  only  as  confused  and  distorted.    Lit.  No.  36. 

"  Perhaps  the  "  not  dreaming "  which  so  many  people  assert  is  only 
a  "not  paying  attention  to  the  dreams." 


THE  DREAM  /I 

possible,  at  least  so  far  as  to  gain  the  conviction  that  the  dream 
is  an  intelligible  formation  and  usually  also  to  gain  a  hint  of  its 
meaning. 

Exactly  in  contrast  to  the  freedom  of  the  individual  to  elab- 
orate his  own  dream  world  in  personal  strangeness  and  thereby 
render  its  comprehension  unattainable  to  others,  there  are  a  num- 
ber of  dreams  which  almost  everyone  has  dreamed  in  the  same 
fashion,  from  which  fact,  it  can  be  assumed  that  they  have  the 
same  significance  for  everyone.  An  especial  interest  attaches  to 
these  "  typical  dreams  "  because  they  probably  arise  from  the  same 
sources  in  all  people,  thus  seem  especially  well  suited  to  give  us 
some  conclusions  concerning  dream  sources.  The  typical  dreams 
of  people  would  be  worthy  a  penetrating  investigation ;  Freud  in 
his  work  only  takes  up  in  detail  some  samples  of  this  class.  One 
of  the  most  widespread  dreams,  the  elucidation  of  which  will  be 
earliest  attainable  to  the  laiety,  is  the  so-called  embarrassment 
dream  of  nakedness,  which  happens  also  with  the  addition  that 
one  was  not  at  all  ashamed,  etc.  Our  interest  is  only  due  the 
nakedness  dream,  however,  when  the  dreamer  feels  shame  and 
embarrassment  in  it  and  wishes  to  fly  or  hide  himself;  in  that 
lies  the  peculiar  inhibition  that  one  cannot  move  from  the  place 
and  feels  powerless  to  change  the  painful  situation.  Only  in  this 
connection  is  the  dream  typical.  As  a  rule,  the  defect  in  the  toi- 
lette is  not  so  bad  as  to  make  the  shame  accompanying  it  seem 
justified.  Freud  has  learned  to  consider  this  nakedness  dream  as 
an  exhibitionist  dream  and  traces  it  back  to  the  active  spontaneous 
disrobing  of  children  which  gives  them  great  pleasure  and  enjoy- 
ment. Aside  from  this  repetition  of  an  infantile  wish-fulfillment, 
the  repression  also  comes  naturally  to  expression  in  the  exhibition- 
ist dream;  the  painful  feeling  in  the  dream  (shame,  etc.)  is 
indeed  a  reaction  because  the  since  abandoned  content  of  the 
exhibitionistic  scene  has  therein  succeeded  in  coming  to  repre- 
sentation. 

A  second  group  of  typical  dreams  which  is  especially  character- 
istic and  important  for  the  neurosis  and  the  family  conflict  under- 
lying it  has  for  content  that  a  dear  relative  (parent,  brother, 
sister,  child,  etc.)  is  dead.  Also  in  these  dreams,  only  those  are 
typical  in  which  one  feels  deep  grief  over  the  death.  According 
to  Freud's  explanation,  these  dreams  signify  exactly  what  their 


72  FREUD  S  THEORY   OF  THE   NEUROSES 

content  says  according  to  the  fundamental  principle  of  wish- 
fulfillment:  namely,  the  wish  that  the  person  in  question  really 
was  dead.  This  interpretation  will  probably  excite  a  priori  indig- 
nant denial  in  everyone.  Nevertheless,  one  must  keep  in  mind 
that  the  hostile  death  wish  against  a  near  relative  need  not  be  an 
actual  one.  The  dream  theory  is  satisfied  in  the  conclusion  that 
the  dreamer  has  wished  the  death  sometime  in  childhood;  this 
wish  springs,  as  a  rule,  from  the  childish  idea  of  life,  in  which 
death  has  only  the  significance  of  a  separation,  an  interruption 
of  the  disturbing  presence  of  a  person,  thus,  a  kind  of  journey 
without  return.*^ 

Among  these  dreams  of  the  death  of  dear  relatives,  the  dream 
of  male  individuals  of  the  death  of  the  father  assumes  a  special 
significance  since  it  occurs  with  these  people  frequently  in  con- 
nection or  alternating  with  the  dream  of  having  sexual  intercourse 
with  the  mother,  a  dream,  the  typical  character  of  which  was 
already  known  to  the  ancients.  This  dream  shows,  therefore,  the 
sexual  wish-fulfillment,  in  contrast  to  other  dreams,  so  crass  and 
undisguised  because  it  is  usually  a  pollution  dream.  Corre- 
sponding to  this  pair  of  dreams  of  male  individuals  is  an  analagous 
pair  with  changed  sexes  but  usually  in  veiled  form  occurring  in 
the  female  sex.*^  This  group  of  typical  dreams  betrays  that 
"  GEdipus-complex "  of  all  people  first  pointed  out  by  Freud 
which  has  found  its  artistic  expression  in  the  celebrated  tragedy 
of  Sophocles.  As  is  constantly  being  more  plainly  shown,  this 
complex  plays  the  leading  part  in  the  childhood  mental  life  of  all 
individuals  who  later  become  psychoneurotics ;  love  for  one,  hate 
for  the  other  of  the  parents  belong  to  the  fixed  condition  of  the 
material  in  psychic  impulses  formed  at  that  time  so  important  for 
the  symptomatology  of  the  later  neurosis. 

Recently  (in  the  second  edition  of  the  Traumdeutung) ,  Freud 
has  treated  exhaustively  some  other  typical  dreams.  Thus,  the 
examination  (proving)  dream  (maturity  dream)  which  belongs  to 
the  most  frequent  of  typical  dreams.    These  anxious  dreams  that 

"  For  this  childish  idea  of  death  compare  Traumdeutung,  page  i8o  and 
"Analyse  der  Phobic  eines  fiinfjahrigen  Knaben." 

"The  disguised  forms  of  the  CEdipus  dream  are  as  frequent  as  the 
undisguised.  Also  this  dream  appears  in  hypocritical  representation  which 
treats  the  rival  tenderly. 


THE  DREAM  73 

one  must  repeat  the  final  examination  (eventually  a  rigorous  one) 
or  a  school  test  always  appear,  according  to  Stekel's  explanation, 
when  one  anticipates  next  day  a  responsible  task  and  the  possi- 
bility of  a  disgrace  which  relates  mostly  to  the  sexual  tests 
(matura-mature,  potent).  The  dream  is,  in  a  way,  a  consolation, 
since  the  dreamer  says :  you  have  also  before  the  examination  had 
anxiety  and  yet  it  went  off  all  right ;  therefore,  nothing  will  hap- 
pen to  you  this  time !  The  following  fact  affords  proof  for  this 
conception:  the  dream  is  only  dreamed  by  persons  who  have 
passed  that  examination. 

At  the  bottom  of  a  great  number  of  dreams  which  are  fre- 
quently accompanied  by  anxiety,  which  have  as  content  the  pass- 
ing from  narrow  rooms  or  being  in  the  water,  lie  phantasies  of 
the  intrauterine  life,  the  stay  in  the  mother's  body  and  the  birth 
act;  one  succeeds  in  interpreting  them  by  inverting  the  facts 
detailed  in  the  dream,  thus,  instead  of  falling  into  the  water,  to 
come  out  of  the  water,  i.  e.,  be  born.^^ 

Robbers,  nocturnal  burglars  and  ghosts,  of  v^rhich  one  is  afraid 
in  the  dark,  and  which  also  occasionally  visit  the  sleeper  in  dreams, 
are  sometimes  memories  of  the  nocturnal  visitors  who  have  at 
that  time  awakened  the  child  to  set  him  on  the  chamber  that  he 
might  not  wet  the  bed  or  to  prevent  onanistic  acts.  (Con- 
cerning the  robber-dreams  of  the  anxiety-neurosis,  compare 
Chapter  VI.) 

Fire-dreams  which  refer  mostly,  on  account  of  the  association 
with  "  playing  with  fire,"  to  a  frequent  eneuresis^*  are,  however, 
usually  overdetermined  by  taking  fire  symbolically  as  standing 
for  passion. 

Of  the  typical  toothache-,  flying-  and  other  dreams,  there  are 
in  the  Traumdeutung  frequent  explanations  which  facilitate  the 
elucidation  of  these  dream  pictures  that  are  often  so  distorted: 
toothache-dreams  apparently  correspond  regularly  to  masturba- 
tion; flying  means  sexual  intercourse.^" 

If  the  dream  is  in  essentials  a  creation  of  the  unconscious,  still 
one  must  not  consider  it  as  a  product  completely  uncontrolled  by 

**  Compare  the  proof  of  this  symbolism  as  an  universial  folk  one  in 
Rank,  "  Der  Mythus  von  der  Geburt  des  Helden." 
"Lit.  No.  21,  page  93. 
*  Compare  Lit.  No.  39,  page  59. 


74  FREUD  S  THEORY  OF  THE   NEUROSES 

consciousness.  Just  as  the  subject  of  hypnosis  has  more  power 
beyond  his  orders  than  one  commonly  supposes,  so  the  dream 
stands  under  a  certain  control  of  conscious  judgment  which  is 
betrayed  in  the  often  radical  interference  of  the  psychic  censor. 
This  explains,  for  example,  how  a  dreamer  starts  up  from  a  dream 
at  the  right  time  to  note  the  solution  of  a  problem,  the  answer  to 
which  had  been  sought  in  vain  by  day.  Thus,  one  understands  the 
consolatory  feeling  so  common  in  dreams  that  it  is  all  a  dream 
(dream  within  a  dream,  Stekel). 

It  is  obvious  that  the  presentation  given  here  cannot  be  a  com- 
plete and  exhaustive  review  of  the  comprehensive  work  on  dream 
interpretation.  Thus,  concerning  affects  in  dreams,  concerning 
absurd  dreams,  nothing  much  has  been  said;  this  is  to  be  found 
at  first  hand  in  Freud's  fundamental  work;®*  in  general,  a  close 
study  of  this  is  indispensable  for  the  scientific  appreciation  and 
application  of  dream  interpretation.  The  importance  of  the  art 
of  dream  interpretation  for  the  psycho-analytic  treatment  of 
psychoneurotics,  Freud  has  shown  in  detail  in  his  "  Bruchstiick 
einer  Hysterieanalyse  "  where  two  dreams  of  a  patient  are  inter- 
preted and  synthetically  assembled  and  utilized  psycho-analytically. 

"An  English  edition  of  this  book  has  been  prepared  by  Dr.  A.  A. 
Brill,  of  New  York,  and  published  by  Macmillan  Co.,  of  New  York,  and 
Geo.  Allen,  of  London,  1912. 


CHAPTER  VI 

HYSTERIA 

Freud's  Position  in  the  Study  of  Hysteria.  Repression  and  Conver- 
sion. Sexuality  and  Infantilism.  The  Hysterical  Mind.  The  Hysterical 
Symptom:  its  Somatic  and  Psychic  Foundations.  The  Hysterical  Phan- 
tasies. The  Hysterical  Attack.  Nervous  Disturbances.  Neurotic  Anxiety 
(Anxiety-Dream,  Anxiety- Hysteria,  Phobia).    Concerning  the  Psychoses. 

Since  the  "  Studien  iiber  Hysterie  "  which  Freud  published  in 
collaboration  with  Breuer  in  1895,  the  essential  features  of  which 
were  reviewed  in  the  general  theory  of  the  neuroses,  he  has  not 
made  a  systematized  presentation  of  the  insight  and  progress  since 
gained  in  the  subject;  hence  this  chapter  can  afford  no  systematic 
and  well-rounded  picture  but  only  a  cursory  view. 

.  The  psychogenic  nature  of  hysteria  which  had  figured  as  a 
disease  of  the  nerves  until  the  time  of  Charcot  is  already  gener- 
ally recognized  from  the  works  of  Janet,  Breuer  and  Freud. 
Although  the  French  school,  with  P..  Janet  a1^  its  head,  had  already 
accepted  the  conception  of  the  dissociation  of  mind  and  of  the 
unconscious  in  hysteria. ^^till  the  view  of^anet  that  tie  cause  o"t 


the  establishment  of  this  mental  dissociation  was  an  inborn  weak 
ness  of  the  mental  synthesis  was  an  unsatisfactory  j)ne.     llHiQ^ 
Breuer-Freudian  view  put  this  dissociation  and  the  unconscious  in 
tHeir  correct  mutual  relationship  by  mtroducmg  a  dynamic  con- 
ception:  tne  mental  life  is  represented  as  a  play  01  iih|^enniU'*Jind 
inhibiting  f^frpg  anrl  if   in  rtnp  ff\'3e.  a  group  of  ideas  remain  in 

tVip  nnrnr[«;riQn<;    an  artivp  rnvLfliri-  Y{'^ih  r^tViPr  p-rnyp's  of  Meas  llaS 
caused  t|]f  icr>loti'r.n  or>A  fViP  ii|^prfpsr.iniisnpss  of  the  first  group. 
Thus,   the  peculiarity,  of   tl\s  FremJiRji    coacaptioft— lies  -k^-theyl 
^'Irepressipn."    The  analysis  proves  that  such  repressions  play  an  | 
extraordinarily  important  role  in  our  mental  life,  that  they  may  • 
also  frequently  miscarry  in  the  individual  and  that  this  failure  of  I 
the  repression  is  the  prerequisite  of  the  symptom   formation.^ 
Psycho-analysis  has  not  only  enabled  us  in  this  manner  to  formu- 
late the  theory  of  the  psychic  conflict  and  the  repression  but  also 

75 


76  freud's  theory  of  the  neuroses 

to  give  the  answer  to  the  question,  whence  comes  such  a  repression 
compelling  strife  between  the  ego  and  individual  groups  of  ideas. 
It  deals  with  that  deep  antagoni«^m  hptw<^f>n  tht^  i'ngfi'npf<^  w!l'^^ 
erve  sexuality  and  the  gaining  of  sexual  pleasure  and  those  other 
instincts  which  have  as  a  goal  the  constitution  of  the  personalilv. 
the.egQiiiigtincts.  The  ego  feels  itself  thrpatpnpH  hv  tVip  ^j^rn^nHg 
oj  the  overpowering  sexual  instinct  and  seeks  .lo  ,£rptect  itself 
by  repressipn.  fMt^tJll  foulrl  show  further  that  thp  nltimatp  "aiisp 
of  the  neurosis  arose  in  early  childhood  where  the  instinctive  life, 
strengthened  under  certain  constitutional  conditions,^'  favors  the 
failure  of  the  repression.  The;;  hvstpnVal  repression  finds  its 
analogue  respprtingr  i't<;  p|-p^pq.i;  "i  liii p    ■■  i  i       ny  L^^yr- 

p^nted  out  under  sexuality  of  children,  in  the  p^rmally  appearing 
"organic  repression  of  the  cfijld'*;  ingti'nffi'vp  and  sexual~!r!e. 
This  repression  is  the  preliminary  ^pndifi'on  of  ih^t  Jatef  ^Y':^''- 
ical  repression  whi(;;j]  j^  nr^y  /-^♦^pf'^v.^^pil^la  tliTpiig-|^  j-j^P  rimi"^~ 
kance  tnat  the  individual  already  possesses  a  store  of  memories 
which  are  withdrawn  from  conscious  disposition 'SMd  wiiieh-aow 

'^"tthfi  b""^*^'"^  aggoriation  Ipavlngr  tlipm  fr^p'  ffofri  ronghrms- 
pes^s  to  ^xercise  thp;  c^hUT^^'^g  p^^'^*'^"  ^^  thp_rpprp«;c;i'nn  Thus, 
/the  sexually  mature  neurotic  individual  brings  witlTKirrrTegularly 
j  some  sexual  repression  from  his  childhood  which  comes  into 
I  influence  in  the  demands  of  real  life  and  leads  to  conflicts.  The 
I  flight  from  unsatisfying  reality  which  is  never  without  an  imme- 
I  diate  gain  of  pleasure  for  the  patients,  the  return  to  earlier  phases 
I  of  the  sexual  life  which  at  that  time  did  not  lack  a  certain  satis- 
I  faction,  thus  as  it  were,  an  infantile  condition  of  the  sexual  life 
I  is  reestablished. 

Only  through  the  disclosure  of  the  fundamental  etiological 
importance  of  the  psycho-sexual  development  for  the  establish- 
ment of  the  neuroses  has  hysteria  ceased  to  be  a  "  child  of  sorrow  " 
of  medical  science  for  all  earlier  theories  have  led  to  no  solution 
or  to  an  only  partially  satisfactory  interpretation  and  explanation 
of  this  strange  disease.  Freud  has  both  lifted  the  veil  from  the 
hysterical  mental  condition  and  also  shown  the  abundant  and 
widely  ramifying  psychic  determination  of  the  symptom.  He  has 
uncovered  the  motives  and  the  content  of  the  hysterical  symptoms 
and  of  the  attack  as  well  as  the  phantasies  lying  at  the  bottom  of 
"  Compare  A.  Adler,  "  tJber  neurotische  Disposition,"  Jahrb.,  I,  2. 


y''^^ 


HYSTERIA  "JJ 

them.  As  you  might  say,  Freud  has  brought  method  out  of 
madness.  His  results,  in  this  his  particular  field  of  investigation, 
have  not  sprung  from  speculation  but  from  pure  empiricism  and 
could  not  have  been  found  earlier  by  any  other  way  than  that 
of  psycho-analysis.  On  the  contrary,  Freud's  investigations  have 
not  dealt  essentially  with  that  part  of  hysteria  which  the  medicine 
of  the  schools  sees  in  hysteria  and  considers  as  important  for 
diagnosis,  namely,  the  stigmata.  Freud  has  always  considered  the 
pathological  phenomena  of  hysteria  from  their  psychogenesis  and 
it  is  in  just  this  field  that  psycho-analysis  gaining  its  popular  value 
as  therapy  has  shown  its  ideal  value  for  investigation  most  splen- 
didly. If  in  such  a  penetrating  presentation  of  the  mental  proc- 
esses, the  clinical  histories  of  hystericals  read  like  novels,  it  lies 
in  the  nature  of  the  object,  in  the  internal  relationship  between  the 
story  of  suffering  and  the  disease  symptom  to  which  physicians 
must  accustom  themselves. 

Strange  ideas  concerning  the  pathological  changes  in  the  genital 
sphere  which  might  constitute  the  starting  point  for  hysterical 
troubles  were  held  by  the  ancient  Greeks  and  Romans.     These 
basic  thoughts  have  been  accepted  in  modified  form  in  the  last 
decades  by  a  number  of  scholars,    Freud  has  taken  all  these  indis- 
tinct presentiments  of  the  mystics  and  although  he  cannot  avoid 
admitting  that  somatic  disturbances  of  the  elaboration  of  the 
sexual  material  in  the  ultimate  analysis  lie  at  the  bottom  of  these 
phenomena,^*  still  he  has  shown  the  predominant  part  of  psycho- 
sexuality  in  the  pathogenesis  of  hysteria  in  widest  measure.    Th^?\ 
chief  content  of  the  mental  structure  of  hystericals  is,  according    \ 
to  the  results  of  psycho-analytic  investigations,  formed  by  the       \ 
"love-life"   in   its  broadest   sense,   together  with   its   intensive       1 
phantasies.    Whoever  is  skeptical  on  this  point  nowadays  plays       I 
a  role  scarcely  tenable  since  the  association  investigation  has      / 
provided  exact  proof  for  the  fact  that  such  emotionally  toned     / 
erotic  complexes  .r^^*'  ^^r  fflf"^^^   pictufe^of '"Hysteflcalta.     jThis    I 
chiefcontent  of  'C^p-  vnt^r\\^^^\^c\\\r^j^^^\^^'ex\c.'?\9,  is  rea'ilv  often    i 
hidden  from  superficial,  observation  or  sVmt)oIical'!v"'  1  ^'|J1  tjlatiiHed   / 

"If  the  reproach  should  be  made  against  the  Freudian  theory  that  as  / 
a   purely  psychological   conception  it  is  unable  to   solve  a   pathological 
problem,  the  same  is  not  justified.    No  one  can  deny  the  sexual  function 
in  the  special  relations  of  which  Freud  sees  the  essence  of  hysteria,  the 
characteristic  of  an  organic  factor. 


I 


78  freud's  theory  of  the  neuroses^ 

like  sexual  matter  in  the  dream.  INeverthelesSjKjifcJiJjiSifitical 
TwiH  is  rnntrolled  from  childhood  on  by  powerful  TOTinterimpulses 
agamst"~Ttieir  abnoi  null  y  ~5trong  TiisHnctive  impulses.  Only  Tig^' 
who  knows  the  romance  of  the  hysterical  can  also  bring  the  com- 
prehension of  the  striking  character  chagges  which  stand  in 
closest  connection  to  the  fate  of  his  eroticisnMIT|if  nrpn^roi  p;/^ti^|-o 
of  hvsteq'fj  j'^  •^"'-^hft-  ""^7  '"?mFrthtniii1iil9  rninn  rnn  han  rrrn;;;;, 
nized  that  the  hysterical  fulfills  an  unconscious  wish  with  his 
rnalady  which  should  exemnt  him  from  ihp-  sninfion  r>f  fTT 
\  momentous  erotic  conflict.  On.  this  pointy  ^!^,^f^  ^^  ^  certain  ex- 
i^V^  \  ternal  similarity  between  Freud's  conception  and  tKe  cornmon 

yieW    to    the     extent    that     a     rAr^kiai— tia;ipQt-;^r^/-o    tynU^o     |lip    lat^nf 

hysterical  notoriously  ill.  Later  inyy,sticratinn^  how£ver,  pho^« 
tnese  recent  experienrps  \q  hp  rpgnlarly  <^9pflirts  of  |he  eroticism 
(a  disappointment  in  love,  a  compulsory  or  renounced  gn^age- 
ment,  a  sexual  assault,  a  sudden  sexual  enlightenment),  ^yd  when 
to. superficial  observation,  there  seem  to  be  other  motives  (nursing 
the  sick,  deaih  ot  a  relative,  etc.).  a  .more  penetrating  investiga- 
tion regularly  reveals  unconscious  attfirTimpni-g  hptwp^p  these  banal 
''^Tntf  '^"'^  '^'^^y'^]  or>A  ^'i^f^ntilp  I'mpj-^^t^t^jong  Thus,  the  hysteric'aT 
patients  Suffer  from  remj^r|]''i^<='"^pf     Tl^p  f]x^ti(;)n  of  certain  mentar 

ir?.prpccir^j^c         I  '       I         ^  r       n    ViP^p^lif PnpH    iVrjf oKili'tjr    p|-    |pnf]- 

^ru^Y  tP  fi^-^^i'^"  ■f^'-  thf-ir  impressiorif;— js  onp  of  thp  most  im- 
portant and  practically  significant  charar^^ri5^|iVg  r.f  fViP  npnrrxi^i^g  t 
The  reaction  to  the  recent  experiences  seems  inappropriate 
when  one  does  not  take  into  consideration  as  motives  the  real 
reminiscences  in  the  unconscious.  Thus  are  explained  the  over- 
powering or  exclusive  reactions  to  sexual  excitations  with  feel- 
ings of  discomfort  in  which  Freud  sees  a  sure  sign  of  hysteria 
whether  the  person  shows  a  somatic  symptom  or  not.  Doubtless 
this  peculiarity  has  the  closest  relationship  as  to  content  with  the 
previously  mentioned  abnormal  constitutional  forces  of  instinct 
and  the  combative  tendencies  of  these  and  further  an  historical 
connection  with  the  earlier  repressions. 

I^urther.  the  hysterical  traits  of  being  suggestible  and  easily 

^  hypnotized  seem  to  have  found  the"liitlierl:o  laCRtflg  g'XplanationIn 

psvcho-fifialygig     TTfoii^  believes  that  the  essence  of  hypnosis  is 

to  be  found  in  the  unconscious  libidinous  fixation  on  the  person  of 

the  hypnotizer  and  Ferenczi,  in  his  study,  "  Intro jektion  und 


HYSTERIA  79 

■Qbertragung  "  (Jahrb.  I),  has  sought  the  proof  of  this  phenomenon 
at  the  bottom  of  the  "  parent  complex." 

If  this  pecuHar  nature  of  hystericals  may  thus  be  understood 
as  coming  from  a  special  psycho-sexual  basis,  the  origin  of  the 
mysterious  symptoms  of  hysteria  must  be  correspondingly  eluci- 
dated. The  theory  of  the  pathogenesis  of  the  hysterical  symptoms 
forms,  as  we  have  cursorily  shown  in  the  history  of  the  develop- 
ment of  the  Freudian  theory  of  the  neuroses  (Chapter  II),  the 
starting  point  for  Freud's  investigation  of  the  psychoneuroses.  ,  t\fT\C2 
The  disc'^Yf'^'^  w^1VV1  Prai.^^  ^^a^  ir^  4-v.,><-  p».««i;r.^  cr,^^^  ^f  t^yoi  '-"-"^ 

texia  that  somewhat  analogously  to  the  traumatic  hysteria,  thei 
ordinary  hysteria  owes  its  symptoms  to  dream-like  mental  im-'.^^^^ 
pressions.  was  the  startinp^  point  of  the  theory  of  hvsteria  lat^y  hj^ 
elaboratefll^Y  FrpnH     The  sexual  traumatic  experiences,  sinc^e  tl^i^  * 
ideas  which  accompanied  these  had  powerful  affecti   (sum  oj 
excitation^  which  had  not  been  abreacted  by  the  normal  reactlo. 

of   COmmr^j^rltiP"    """^    ^^'^    r^r.rr^cp^nr^;r.gr    pyprpccmr^    qf    |>mnfi'r.r 

might  become  the  raiigp  nf  kiiatgrir^Lsvmntnms  whpn  th^s  ac.car 
panying  affect,  separated  from  the  unbearable  idea^  was  appli^ 
to  the  formation  of  a  physical  symptom.^^    In  part,  tliese  "pent-l 
up"  affects  remain  as  lasting  burdens  of  the  mental  life  and! 
sources  of  constant  excitation  to  the  same;  in  part,  they  accom-l 
plish  a  transformation  into  uncommon  physical  innervations  andU 
inhibitions  which  manifest  themselves  as  the  physical  symptoms  i\ 
of  the  case.    Breuer  and  Freud  coined  for  the  last  process  the 
name  "  conversion."     For  the  comprehension  of  this  term,  the 
reference  to  the  "  expression  of  the  emotions "  which  normally 
betrays  our  mental  excitement  is  of  service;  this  the  hysterical 
conversion  exaggerates  as  well  as  leads  into  collateral  channels. 
The  psycho-physical  tendency  to  conversion  represents  a  part  of 
the  hysterical  disposition.    Though  the  nature  of  conversion,  the 
transformation  of  psychic  excitation  into  physical  innervation  is 
still  a  problem,  Erp^id  has,  nevertheless,  thr^y^ji  his  ft^ff"^  invp.sti-  J  J  )  '^^ 
gation  been  able  to  make  important  contributions  concerning  the      "'''    \^ 
direciiort  Wflich  ih^  'i^Ori'iT''''''^"  ^^Vfi  ^"  infllY^<^^^^  cases,  now  caus-  ^Qr^^' 
ing  the  paralysis  of  some  particular  part  of  the  body,  again  an   --'''''" 

**  Experience  shows  that  the  conversion  does  not  follow  immediately 
the  causative  event  but  that  a  long  interval  may  intervene  before  the 
establishment  of  the  symptom. 


; 


:^^^  f 

P^ 

^  n 


80  freud's  theory  of  the  neuroses 

erical  cough  or  vomiting,  etc.'*'  If  his  discoveries  in  the 
psychological  ItJlUl'lUiiij  aiid^  determinations  to  be  discussed  "later  is 
1  to nbe  dAflSiaSf^d  as  1^'reud's  greatest  work,  still,  he  has  never 
'  /  failed  to'^phasize  distinctly  tliat  eyfrv'TiycifprTrat  cyrnprnm  hfi'^ 
^not  only  a  psychic  oripn  but  also  a  somatic  hasisand  (;?^n  on]vcQiTie 
to  expression  wlieji  n  '-'^i-^-^'"  ^^j^xy^-xt^i^  "p^^p-^f^rlnpco "  (^"  somatis- 
ches  Entgegenkommen")  is  at  hand;  this  is  provided  by  a  normal 
or  pathological  process  in  or  on  an  organ  of  the  body.  This  somatic 
preparedness  consists  of  numerous  conditions:  first  is  the  way 
already  prepared  by  physical  conditions  of  irritation  of  these 
organs,  for  example,  the  establishment  of  an  hysterical  cough 
from  an  acute  catarrh.  A  much  more  important  condition  of 
somatic  preparedness  is  when  the  affected  organ  represents  an 
erogenous  zone.  In  this  connection,  Freud  ha'?  i^nmtpr^  pnf  fViat 
iust  as  in  children  the  erogenous  peculiarity  can  be  moved  to  any 
favorite  body  zone  so  an  analop^ous  movability  returns  in  the 
iptomatology  of  hysteria."^  In  this  neurosis,  the  repression 
concerns  the  actual  genitals  for  the  most  part;  these  give  their 
irritaDiiity  to  the  other  zones  which  ordinarily  possess  little  such 
function  and  these  latter  then  behave  exactly  like  genitals.  Thus 
for  example,  an  hysterical  vomiting  might  arise  in  an  individual 
for  whom  the  mouth  zone  was  preeminently  emphasized  in  child- 
hood and  yielded  a  pleasure  (sucking)  ;  the  later  repression  of 
this  pleasurable  sucking,  because  of  the  close  connection  of  the 
mouth  zone  with  the  instinct  of  hunger,  might  encroach  on  the 
latter.  All  of  Freud's  patients  with  disturbances  of  eating,  hys- 
terical  p^lobus.  jf^ftPrr  ^'"  ^^^  tll^^^^  ^If*  yomitinp^  Ti^H  h^^^n-pnpr- 
jetic  suckers  in  childhood.  In  this  fashion,  all  hysterical  abulias 
come  about,  since  tne  organs  or  systems  of  orp^aiVH  wliii  li>.4»erv<^ 
these  two  instincts  when  they  deny  the  erogenous  function  also 
refuse  to  serve  in  their  other  junction,  "inus  arises,  lor  example, 
an  hysterical  disturbance  of  the  gait  (abasia)  if  the  motor  move- 
ment in  a  phase  of  childhood  had  received  strong  erogenous  em- 

•* Concerning  conversion  into  anxiety,  compare  "anxiety-hysteria" 
in  latter  part  of  this  chapter. 

•*With  the  typical  symptoms,  the  so-called  stigmata,  formerly  greatly 
overvalued  as  signs  of  hysteria,  Freud  has  not  dealt  closer  than  occasion- 
ally to  point  out  that  the  movability  of  the  erogenous  zones  has  also  here 
the  greatest  significance:  erogenous  and  hysterogenous  zones  show  the 
same  characteristics 


HYSTERIA 


8i 


phasis  which  later  became  repressed.®^  That  the  disturbance  can 
turn  to  different  organs  rests  on  the  fact  that  corresponding  to  the 
component  instincts  and  the  perversions  connected  with  them, 
besides  their  regular  organic  functions,  these  organs  also  serve  in 
childhood  the  most  diverse  erogenous  functions.  The  mouth 
serves  for  kissing  as  well  as  for  eating  and  the  speech  function 
(hysterical  vomiting,  mutism) ;  the  eyes  receive  stimuli  in  order 
to  perceive  not  only  the  changes  in  the  external  world  important 
for  the  preservation  of  life  but  also  the  peculiarities  of  objects  by 
which  these  are  raised  to  objects  to  be  loved  (hysterical  disturb-  , 

ances  of  vision).  'j)nES^ 

According  to  Freud,  for  the  establishment  of  an  hysterical 
symptom,  the  displacement  of  sexual  feeling  also  plays  a  role. 
Thus,  nausea  may  arise  in  a  girl  who  perceives  a  genital  sensation 
on  the  occasion  of  a  kiss ;  by  displacement,  this  sensation  is  per- 
ceived as  a  feeling  of  discomfort  in  the  mouth  and  digestive  zone. 
The  same  girl  suffers  from  an  hysterical  pain  in  the  breast  since, 
during  an  embrace,  she  felt  the  pressure  of  an  erect  penis  against 
her  thigh.  Thus,  here  we  have  to  deal  with  the  displacement  to 
the  breast  of  a  tactile  impression  on  the  thigh  converted  into  an 
hysterical  pain. 

More  important  than  the  reference  to  the  somatic  conditions 
of  the  symptom  and  Freud's  particular  masterpiece,  is  the  dis- 
covery of  the  symptom's  psychic  roots.    The  psychic  determina-     ' 
tions  afp  Tin<"  gimpl/^  Knf  mcf^^  f-nmpljcated.    Determination  plays 
animportant  role  through  a  comprehensive  and  widespread  sym- 


bolism  analo£[ous  to  that  of  dream  life.  Thus,  for  example,  m  a 
female~p^^i'='"ti  tb**  ""/^»"g'^'<">iig  pVian^^f^y  i}^_J^^  erect  male  organ 
mayserve  as  model  for  a  stiff  arm ;  at  the  same  time,  however, 
this  symptom  was  the  punishment  tor  an  intended  sexual  aggres- 
sidn  With"  tKeTiand.  As  a  rule,  the  hysterical  symptom  does  no? 
have  merely  a  single  meaning  but  several  meanings  at  the  same 
time  (overdetermination)  ;  these,  it  does  not  possess  from  the 
beginning  but  rather  gains  from  the  thoughts  striving  to  find  ex- 
pression. Since  the  origination  of  a  symptom  is  difficult  and 
joined  to  a  series  of  favoring  somatic  conditions,  it  is  evident  that 
an  hysterical  symptom,  once  formed,  is  retained  to  give  alternate 
expression_tQ-dUifiCS£Ji3ieafli]3gs. 

**  Compare  also  the  agoraphobia  later  in  chapter. 
7 


82 


FREUD^S   THEORY  OF   THE   NEUROSES 


m 


Just  as  certain  presuppositions  are  necessary  for  the  establish- 
ment of  the  symptom,  so  later  circumstances  appear  in  this  con- 
nection which  at  the  beginning  of  the  malady  were  not  present  and 
had  no  share  in  the  symptom  formation;  only  upon  the  later 
appearance  of  these  is  the  disease  fully  established :  tliese  circum- 
s^nces  are  the  motives  for  the  malady.  Wherever  a  train  of 
thought  finds  it  convenient  to  use  a  symptom,  this  becpmes  a 
secondary  function  and  appears  fixed  in  the  mental  life.fThe  pur- 
pose of  the  disease  is  often  to  gain  afifection,  indulgence  or  other 
advantage  from  the  surroundings ;  frequently  a  desire  for  revenge 
is  one  of  the  strongest  unconscious  motives  for  the  further  estab- 
lishment of  the  symptom  and  naturally  a  great  hindrance  to  the 
treatment.  Nevertheless,  there  are  also  cases  with  purely  internal 
motives  such  as,  for  example,  self-punishment,  repentance  and 
peniten^tfjl 

According  to  the  original  view,  it  was  only  the  sexual  trau- 
matic experiences  which  by  their  intensity  and  unbearableness  gave 
occasion  to  the  repression;  deeper  psycho-analytic  investigation 
has  disclosed  the  fact  that  it  is  much  more  the  phantasies  (inven- 
tions of  memory)  of  the  patients,  intensively  elaborated  mostly 
in  the  years  around  puberty  which  interpose  themselves  between 
the  infantile  processes  and  the  symptoms,  the  content  of  which 
can,  under  certain  conditions,  join  the  infantile  repression  of 
instinct  and  be  withdrawn  into  the  unconscious.  So  long  as  these 
fftlfint^''''^''  ^^*^  ^r>p<;rir>ii«;.  -\|vexall  them  day-dreams;  tlicil'  [JU!.Sf»- 
bility  for  b^iny  rporesspd.  tht^ir  becoming  unconscious  rests  on 


tjieir  close  relation  to  the  sexual  life  of  the  persons  m  quest 

The  phantasy,  after  it  has  become  unconscious,  is  really  identical' 
with  the  (conscious)  phantasy  which  the  person  has  indulged  in 
for  sexual  gratification  during  a  period  of  masturbation.  The 
act  of  masturbation  (in  widest  sense,  i.  e.,  onanistic  act)  is  com- 
posed at  that  time  of  two  parts,  the  production  of  the  phantasy 
and  the  active  performance  of  the  self-gratification.  This  com- 
bination displays,  however,  a  line  of  cleavage :  originally  the  action 
was  a  purely  autoerotic  attempt  to  gain  pleasure  from  a  definite 
erogenous  zone.  Later  this  action  blended  with  the  wish  idea 
from  the  circle  of  lovable  objects  and  served  as  a  partial  realiza- 
tion of  the  situation  to  which  this  phantasy  pointed.  If  then,  the 
person  renounced  this  kind  of  masturbation-phantasy-gratification. 


HYSTERIA  83 

the  action  would  be  stopped  but  the  phantasy  would  pass  from  a 
conscious  to  an  unconscious  one.  If  no  other  kind  of  sexual 
gratification  took  its  place,  the  person  remained  in  abstinence  and 
was  unable  to  sublimate  his  libido,  that  is,  divert  the  sexual  excita- 
tion to  higher  aims,  the  condition  was  just  right  for  the  uncon- 
scious phantasy  to  come  to  life,  grow  luxuriantly  and  constitute 
itself  with  the  whole  force  of  the  sexual  appetite  at  least  in  one 
part  of  its  content  as  a  disease  symptom.  For  a  whole  series  of 
hysterical  symptoms,  unconscious  phantasies  of  this  kind  are  the 
nearest  psychic  prototypes.  The  hysterical  symptoms  are  nothing 
else  than  unconscious  phantasies  brought  to  representation  through 
conversion  and  in  so  far  as  they  are  somatic  symptoms  they  were 
often  enough  borrowed  from  the  circle  of  real  sexual  feelings 
and  motor  innervations  which  originally  accompanied  them  when 
they  were  still  conscious  phantasies.  In  this  way,  the  giving  up 
of  onanism  becomes  really  retrograde  and  thereby  the  final  ulti- 
mate aim  of  the  whole  pathological  process,  the  recovery  of  the 
sexual  gratification  at  that  time  primary,  is  never  attained  but 
always  approximated.  The  interest  of  the  student  of  hysteria 
soon  turns  from  the  symptoms  themselves  to  the  phantasies  from 
which  these  were  first  derived.  The  psycho-analytic  method  has 
made  it  possible  to  investigate  these  ultimate  unconscious  disease- 
producing  phantasies  of  people  and  in  Freud's  analysis  of  a  child 
neurosis  (see  lit.  No.  35)  these  could  be  directly  pointed  out  in 
statu  nascendi.  In  this  analysis,  it  was  revealed  that  these 
phantasies  which  intensively  occupy  the  dreamy,  neurotically  pre- 
disposed child  choose  for  their  objects  at  first  the  parents  and  the 
immediate  surroundings  of  the  child,  that  in  this  connection, 
pregnancy-  and  birth-phantasies  as  well  as  infantile  sexual 
theories®^  which  the  unenlightened  child  elaborates  for  the  expla- 
nation of  these  mysterious  processes,  play  an  important  role. 
Since  at  this  time  the  activity  of  the  normal  sexual  zone  does 
not  yet  stand  in  the  foreground,  the  child  being  thus  still  poly- 
morphous-perverse, these  phantasies  serve  the  most  diverse  erotic 
desires  and  as  the  difference  in  sex  is  still  also  a  problem  for  the 
child,  these  phantasies  are  also  bisexual.  The  fact  that  in  general 
the  same  phantasies  concerning  childhood  are  always  formed 
without  regard  to  how  much  or  how  little  actual  material  real  life 

"Lit.  No.  32. 


84  freud's  theory  of  the  neuroses 

has  added  to  them,  is  explained  by  the  uniformity  of  the  child's 
sexual  life  and  the  later  modifying  influences.®* 

Psycho-analytic  investigations  of  neurotics  plainly  reveal  the 
fact  that  the  growing  individual  seeks  to  eflface  in  his  phantasy- 
formations  concerning  his  earliest  childhood  the  memory  of  his 
autoerotic  activity,  at  the  same  time  raising  his  reminiscences  to 
the  stage  of  love-of-an-object.  Hence,  the  superabundance  of 
seductions  and  outrages  in  these  phantasies,  where  often  enough 
the  reality  is  limited  to  autoerotic  activity,*"  a  distinction  which 
in  forensic  cases  must  occasion  the  judge  the  greatest  difficulties. 
The  correct  distinction  between  the  phantasies,  afterwards  sexual- 
ized,  and  the  actual,  as  a  rule  banal  events  of  childhood,  is  ren- 
dered very  difficult  by  the  fact  that  in  the  neurosis,  thought-reality 
and  not  actual  reality  has  value. 

Freud  has  enunciated"  a  series  of  formulae  which  attempt  to 
treat  exhaustively  and  progressively  the  nature  of  the  hysterical 
symptom.  These  do  not  contradict  one  another  but  correspond 
in  part  to  more  complete  and  sharper  delineations,  in  part  to  the 
use  of  different  points  of  view : 

1.  The  hysterical  symptom  is  the  memory-symbol  of  certain 
actual  (traumatic)  impressions  and  experiences. 

2.  The  hysterical  symptom  is  the  substitute  created  by  con- 
version for  the  associative  return  of  these  traumatic  experiences. 

3.  The  hysterical  symptom  is — ^like  other  psychic  formations 
— ^the  expression  of  a  wish- fulfillment. 

4.  The  hysterical  symptom  is  the  realization  of  an  unconscious 
phantasy  which  serves  the  wish-fulfillment. 

5.  The  hysterical  symptom  serves  the  end  of  sexual  gratifica- 
tion and  represents  a  part  of  the  sexual  life  of  the  person  (corre- 
sponding to  one  of  the  components  of  his  sexual  instinct). 

•*In  individuals  especially  constituted  by  their  heredity,  hysteria  may 
break  out  in  childhood  from  these  conditions,  usually  in  the  form  of 
anxiety-hysteria. 

"It  must  be  constantly  borne  in  mind  that  the  hystericals  are  in- 
clined in  their  phantasy-life  to  produce  injurious  dreams  and  to  conceal 
them  because  of  the  accompanying  pleasure  gained.  Abraham,  "Das 
Erleiden  infantiler  Sexualtraumen  als  Form  der  infantilen  Sexualbetati- 
grung,"  Zentralhlatt  f.  Nervenh.  «.  Psych.,  1907.  A  series  of  dreams  com- 
ing to  light  in  the  analysis  may,  nevertheless,  be  traced  back  to  a  later 
phantastic  elaboration  of  autoerotic  sexual  experiences.  Jahrh.,  I,  page 
393. 

-Lit.  No.  28. 


HYSTERIA  85 

6.  The  hysterical  symptom  corresponds  to  the  return  to  a  kind 
of  sexual  gratification  which  was  real  in  infantile  life  but  has 
since  been  repressed. 

7.  The  hysterical  symptom  arises  from  a  compromise  between 
two  opposed  affective  and  instinctive  impulses  by  which  the  one 
brings  a  partial  instinct  or  component  of  the  sexual  constitution 
to  expression,  the  other  seeks  to  suppress  the  same. 

8.  The  hysterical  symptom  can  become  the  representative  of 
different  unconscious  non-sexual  impulses  but  cannot  be  without 
a  sexual  meaning. 

Among  these  definitions,  it  is  the  seventh  which  most  exhaust- 
ively expresses  the  nature  of  the  hysterical  symptom,  as  realiza- 
tion of  an  unconscious  phantasy.  When  one  in  this  manner,  by 
means  of  psycho-analysis,  succeeds  in  recognizing  the  component 
of  the  sexual  instinct  which  is  controlling  the  individual,  one 
comes  upon  the  unexpected  discovery  that  for  many  symptoms 
the  solution  by  the  original  unconscious  sexual  phantasy  is  not 
sufficient,  but  that  one  needs  for  the  solution  of  the  symptom  two 
sexual  phantasies,  of  which  one  has  a  masculine  character,  the 
other  a  feminine,  so  that  one  of  these  phantasies  arises  from  an 
homosexual  impulse.    Thus, 

9.  An  hysterical  symptom  is  the  expression,  on  the  one  hand 
of  a  masculine,  on  the  other  hand,  of  a  feminine  unconscious 
sexual  phantasy. 

Freud  believes,  however,  that  no  universal  application  can  be 
made  of  this  occurrence  of  two  opposite  sexual  tendencies  in  one 
symptom  as  in  the  other  formulae,  important  though  it  is  theoret- 
ically and  also  not  to  be  underestimated  in  practice.  A  counter- 
part of  this  hermaphrodism  of  the  hysterical  symptom  is  shown 
by  certain  hysterical  attacks  in  which  the  patient  plays  both  roles 
at  the  same  time  in  the  underlying  sexual  phantasy.  This  contra- 
dictory synchronism  conditions  in  large  part  the  incomprehensi- 
bility of  the  situation  otherwise  so  plastically  represented  in  the 
attack  and  is  thus  suited  for  disguising  the  actual  unconscious 
phantasy. 

Freud  has  really  shown  that  the  attack,®^  this  most  imposing 
symptom  of  hysteria,  is  also  nothing  else  than  a  phantasy  trans- 
lated   into   motor    phenomena,    projected    into   motor   activity, 

•^Lit.  No.  33. 


86  freud's  theory  of  the  neuroses 

represented  in  pantomime  and  that  by  witnessing  this,  it  is  pos- 
sible to  recognize  the  phantasy  dramatized  in  the  attack;  this 
procedure  alone  succeeds  only  rarely.  As  a  rule,  the  pantomimic 
representation  of  the  phantasy  has  undergone  under  the  influence  of 
the  censor,  distortions  quite  analogous  to  the  hallucinatory  ones  of 
the  dream,  so  that  both  alike  have  become  incomprehensible  for 
the  patient's  consciousness  and  for  that  of  the  observer  as  well. 
The  hysterical  attack  may  thus  undergo  the  same  important 
elaboration  that  we  see  in  nocturnal  dreams.  Thereby,  one  is 
easily  convinced  that  not  only  the  forces  from  which  the  distor- 
tion proceeds  and  the  purpose  of  this  distortion  are  the  same  but 
also  the  technique  is  the  same  as  that  which  we  have  recognized 
in  the  interpretation  of  dreams. 

The  hysterical  attack  is  rendered  incomprehensible,  indistinct, 
distorted  and  misleading : 

1.  By  condensation  of  several  simultaneous  phantasies,  for 
example,  a  recent  wish  and  the  revival  of  an  infantile  impression. 

2.  By  multiple  identification  when  the  patient  undertakes  to 
carry  out  the  activities  of  both  persons  appearing  in  the  phantasy. 

3.  By  the  antagonistic  conversion  of  the  innervation  which  is 
analogous  to  the  change  of  an  element  to  its  opposite  practiced  in 
the  dream-making,  for  example,  if  in  the  attack,  an  embrace 
would  be  represented,  the  arms  would  be  drawn  backwards  con- 
vulsively. As  far  as  possible,  the  recognized  "  arc  de  cercle  "of 
the  great  hysterical  attack  is  nothing  else  than  such  an  energetic 
denial  through  antagonistic  innervation  of  a  position  of  the  body 
suitable  for  sexual  intercourse. 

4.  By  the  inversion  of  the  time  sequence  in  the  phantasy  rep- 
resented, which  again  finds  its  counterpart  in  many  dreams  which 
begin  with  the  end  of  the  action  in  order  to  conclude  with  its 
beginning.  The  outbreak  of  the  hysterical  attack  follows  easily 
understandable  laws.  Since  the  repressed  complex  consists  of 
libido  and  content  of  ideas  (phantasy),  the  attack  can  be  occa- 
sioned by :  ( I )  Associations,  when  the  complex  (  sufficiently  deep 
rooted)  is  touched  upon  by  something  of  conscious  life;  (2) 
organically,  when  from  somatic  causes  and  from  psychic  influ- 
ences from  without,  the  amount  of  libido  is  increased  beyond  a 
certain  measure;  (3)  in  the  service  of  the  primary  tendency,  as 
expression  of  "the  flight  into  sickness"  when  reality  becomes 


HYSTERIA  87 

painful  or  dreaded,  thus,  for  consolation;  (4)  in  service  of  the 
secondary  tendencies  with  which  the  disease  has  united  so  that 
by  the  production  of  an  attack,  an  advantage  to  the  patient  is 
gained. 

The  investigation  of  the  childhood  history  of  hystericals 
teaches  that  the  hysterical  attack  is  also  used  as  a  substitute  for 
autoerotic  gratification  once  practiced  and  since  renounced.  In 
a  great  number  of  cases,  this  gratification  (masturbation  by 
rubbing  or  pressing  the  thighs  together,  sucking  the  tongue,  etc.) 
also  returns  in  the  attack  during  a  relaxation  of  consciousness. 
The  involuntary  micturition  should  certainly  not  be  considered 
inconsistent  with  the  diagnosis  of  hysterical  attacks ;  it  can  repeat 
the  infantile  form  of  impetuous  pollution.  Further,  one  can  also 
encounter  the  biting  of  the  tongue  in  undoubted  hysteria. 

The  loss  of  consciousness,®^  the  "absence"  of  the  hysterical 
attack  proceeds  from  those  transitory  but  unmistakable  failures 
of  consciousness  which  are  to  be  detected  at  the  height  of  every 
intense  sexual  gratification  (also  in  the  autoerotic  forms).  In 
the  origination  of  the  hysterical  "absences"  from  pollution- 
attacks  of  young  female  individuals,  this  development  may  be  fol- 
lowed most  clearly. 

The  arrangement  which  opens  the  way  for  the  repressed  libido 
to  find  an  outlet  is  that  already  present  reflex  mechanism  of 
coitus  present  in  every  man  and  also  in  women  which  we  see 
become  manifest  in  its  unrestricted  devotion  to  sexuality.  The 
ancients  used  to  say  "  coitus  is  a  little  epilepsy."  We  may  alter 
this  to  "  the  hysterical  convulsive  attack  is  a  coitus  equivalent." 

In  conclusion  of  the  symptoms  of  hysteria,  the  so-called 
"  nervous  disturbances,"  which  play  a  great  role  in  practice,  may 
also  be  discussed. 

If  one  overlooks  the  ill-defined  classes  of  "being  nervous," 
the  nervous  disturbances  according  to  Freud  belong  in  the  field 
of  sexual  neuroses.  The  description  of  the  true  neuroses  included 
already  a  wide  array  of  psychic  and  somatic  nervous  disturbances 
for  which  a  toxic  cause  is  assumed :  nervous  anxiety,  irritability, 
nervous  palpitation,  headache,  stomachache,  sweating,  trembling, 
diarrhea,  vertigo  and  many  others. 

"Compare  Abraham,  "t)ber  hysterische  Traumzustande,"  Jahrb.,  II, 
I,  1910. 


88  freud's  theory  of  the  neuroses 

Opposed  to  these  neuroses  of  the  heart,  intestine,  "  vasomotor 
neuroses,"  etc.,  or  associated  with  them  are  very  often  in  indi- 
vidual cases  psychogenic  symptoms  which,  when  isolated,  appear 
as  mono-symptomatic  hysteria.  Thus,  for  example,  a  nervous 
nausea,  nervous  vomiting,  dyspepsia  ("stomach  neurosis")  has 
the  same  mechanism  of  origin  as  the  same  symptoms  in  the  course 
of  an  hysteria.*®  When  a  nervous  vomiting  seems  apparently  to 
be  determined  by  a  recent  event  and  a  somatic  preparedness 
(Entgegenkommen),  indeed  if  occasionally  a  cure  by  abreaction 
of  recent  experiences  seems  to  have  been  effected,  nevertheless, 
behind  this,  a  determination  from  childhood  is  to  be  discovered 
under  which  in  the  ultimate  analysis  lies  an  erogenous  strengthen- 
ing of  the  mouth-digestive  zone. 

The  same  applies  to  psychic  impotence  in  which,  often  a 
recent  experience,  a  single  failure,  seems  to  inhibit  later  results 
by  anxiety,  while  in  reality  the  hindrance  comes  from  unconscious 
infantile  complexes,  such  as  the  family-complex  (unconscious 
fixation  of  the  libido  upon  mother  or  sister)  which  prevents  the 
transference  of  the  libido  to  the  later  sexual  object.  Of  course  an 
organic  weakness  of  the  sexual  system  or  a  true  neurosis  may 
share  in  this  as  Steiner  and  Ferenczi  could  show.^°"  Although 
the  psycho-analytic  treatment  is  effective  in  psychic  impotence, 
still  the  share  of  the  actual  conditions  is  likewise  to  be  taken  into 
consideration.^"^ 

In  women,  the  condition  corresponding  to  this  is  sexual 
anesthesia  which  very  frequently  accompanies  hysteria  but  is 
also  otherwise  so  enormously  widespread  that  one  must  connect 
it  with  our  all  too  Puritanical  system  of  female  education.  Freud 
was  able  to  trace  this  sexual  anesthesia  back  to  the  following 
condition:  after  the  irritation  of  the  clitoris  by  masturbation 
which  occurred  in  childhood,  the  normally  occurring  transference 

"•Here  belong  the  disturbances  of  appetite  in  children  which  are  so 
important  in  practice  and  often  last  for  months.  Idiosyncrasies  against 
certain  foods  are  likewise  often  of  psychogenic  origin. 

*•" Steiner,  "Die  funktionelle  Impotenz  des  Mannes  und  ihre  Behand- 
lung,"  Wiener  Med.  Presse,  1907,  No.  42.  Ferenczi,  "Analyt.  Deutung 
und  Behandlung  der  psychosexuellen  Impotenz  beim  Manne,"  Psychiatr.- 
Neurolog.  Wochenschr.,  No.  35,  1908. 

*•*  A  cure  attained  by  other  means,  as  suggestion,  cannot  be  considered 
as  an  argument  against  a  complicated  psychogenesis. 


HYSTERIA  89 

of  the  excitability  of  the  clitoris  to  the  adjoining  female  parts 
(vagina),  as  is  necessary  for  the  sensibility  in  the  normal  sexual 
act,  is  retarded  or  is  prevented  altogether.  Further,  this  trans- 
ference normally  demands  a  certain  length  of  time,  during  which 
the  young  woman  is  anesthetic.  It  is  recognized  that  this  anes- 
thesia of  women  is  frequently  only  an  apparent  and  local  one. 
They  are  anesthetic  at  the  vaginal  entrance  but  in  no  way  unex- 
citable  at  the  clitoris  itself  or  in  other  zones.  To  these  erogenous 
causes  of  the  anesthesia,  are  added  the  psychic  ones  likewise  con- 
ditioned by  the  repression.  The  psychogenic  part  is  removable  by 
psycho-analysis  during  the  first  years  of  married  life. 

The  nervous  disturbances  have  an  eminently  practical  impor- 
tance for  general  medicine  and,  according  to  Freud's  conception, 
are  very  productive  for  the  most  diverse  specialties  outside  of 
neurology,  for  example,  internal  medicine,  eye,  ear,  etc.,  which 
employ  so  often  the  term  "  nervous."  It  is  evident  that  no  physi- 
cian can  do  without  a  knowledge  of  psycho-analysis  and  especially 
the  viewpoint  of  psychogenesis  and  sexuality  for  the  differential 
diagnosis.  The  most  diverse  neuralgias,  tics,  dyspepsias,  cases  of 
nervous  asthma,  vaginismus,  many  cases  of  hyperemesis  gravi- 
darum, etc.,  seem  to  be  psychically  conditioned  and  subject  to 
psycho-analytic  influence.  There  are  already  works  on  these  dis- 
eases which  point  to  the  psychogenic  etiology  (compare  Drey- 
fuss,^"^  Walthard,^°3  h.  E.  Miiller)i°*  while  TreupeP*'^  and 
Wegele^""  lay  more  stress  on  the  agencies  of  the  true  neuroses. 

In  this  field,  there  must  come  about  a  decision  or  rather  a 
compromise  between  the  standpoint  represented  by  the  internists 
of  all  kinds  that  for  example,  bronchial  asthma  (nervous)  is  an 
intoxication  corresponding  to  an  exudative  diathesis  and  the 
psycho-analytic  disclosure  of  its  psychological  connections.  Thus, 
cases  of  bronchial  asthma  and  conditions  like  migraine,  vaso- 
motor edema  and  others  which  can  occasionally  stand  for  it,  are 

^""tJber  nervosa  Dyspepsie,"  G.  Fischer,  Jena,  1908. 

^ "  Die  psychogene  Atiologie  und  die  Psychotherapie  des  Vaginis- 
mus," Miinchn.  mediz.  Wachenschr.,  1909,  p.  1998. 

*** "  Beitrage  zur  Kenntnis  der  Hyperemesis  gravidarum,"  Psychiatr.- 
Neurolog.  Wochenschr.,  loth  year. 

^^"tJber  Herzneurosen,"  Miinchn.  mediz.  Wochenschr.,  1909. 

iM  «  Uber  den  Zusammenhang  zwischen  Affektionen  der  Genitalorgane 
mit  Storungen  der  Magen-  und  Darmverdauung,"  Med.  Klinik,  1910. 


9©  FREUD  S  THEORY  OF  THE   NEUROSES 

often  plainly  psychically  conditioned.  Asthma  is  an  important 
symptom  of  anxiety-hysteria  and  for  the  anxiety-neurosis  as  well. 
In  the  works  of  Stekel/"  Stegmann/***  and  others  there  apxpear 
valuable  disclosures  concerning  its  psycho-sexual  nature  and  its 
relief  by  psychic  means,  both  of  the  individual  attack  and  the  dis- 
ease in  general.  One  thing  is  certain,  the  toxic  conditions  are 
especially  well  suited  for  psychogenic  complications.  Still,  there 
is  the  difficult  question  as  to  how  the  organic,  toxic  and  psycho- 
genic share  in  the  causation  of  the  symptoms  as  well  as  the  sharp 
differentiation  of  the  still  confused  terms  "  hysterical,"  "  psycho- 
genic" and  "  (toxic) -neurotic." 

In  this  connection,  Freud  has  pointed  out  in  a  recent  article^"' 
on  the  elucidation  of  "psychogenic  visual  disturbances"  certain 
disturbances  which  have  an  organic-toxic  foundation  besides  the 
psychogenic.  When  an  organ  which  serves  both  fundamental 
instincts,  the  ego-  and  the  sexual-,  increases  its  sexual  role,  it  is 
generally  to  be  expected  that  this  will  not  disappear  without 
changes  in  the  excitability  and  innervation.  When  we  see  that 
an  organ  which  otherwise  serves  the  sense  perception,  for 
example,  the  organ  of  vision,  by  the  raising  of  its  erogenous 
value,  immediately  takes  on  the  function  of  a  genital  organ,  we 
will  also  not  consider  toxic  changes  in  it  improbable.  For  both 
classes  of  functional  disturbances  resulting  from  strengthened 
erogenous  significance  both  of  psychological  and  toxic  origin, 
Freud  would,  for  want  of  a  better  term,  retain  the  old  unsuitable 
name  neurotic  and  call  them  sexual-neurotic  disturbances. 

In  the  framework  of  an  attempt  at  a  comprehensive  represen- 
tation of  hysteria,  the  treatment  of  the  anxiety  problem  also  has 
a  place.  Anxiety  as  the  cardinal  symptom  of  a  true  neurosis  we 
have  already  encountered  in  the  presentation  of  the  anxiety- 
neurosis,  where  according  to  Freud  it  was  explained  that  the 
mechanism  of  the  anxiety-neurosis  is  to  be  sought  in  the  sepa- 
ration of  the  somatic  sexual  excitement  from  the  psychic  which 

i«  "  Nervose  Angstzustande." 

^  Stegmann,  "  Zur  Atiologie  des  Asthmas  bei  Kindern,"  Med.  Klinik, 
1908,  29.  Same,  "  Psychotherapie  bei  Asthma  bronchiale,"  Milnchn.  med. 
Wochenschr.,  1908.    Compare  also  Sanger,  Brugelmann,  Goldscheider. 

*-  Lit.  No.  38. 


HYSTERIA  91 

causes  an  abnormal  employment  of  this  excitement.  We  have 
here  to  deal  with  an  anxiety  which  does  not  have  a  psychic  deri- 
vation. Clinically,  the  cases  of  anxiety-neurosis  are  often  seen 
mixed  with  anxiety  derived  from  psychic  sources.  .This  brought 
about  the  creation  by  Freud  of  the  term  "anxiety-hysteria,"  a 
clinical  phenomenon  to  which  Stekel  has  devoted  the  greatest  part 
of  his  book  on  anxiety  conditions  and  their  treatment,  which  is 
especially  important  for  the  practitioner.  In  these  cases,  the 
anxiety  arises  not  only  from  somatic  sources  but  from  a  part  of 
the  ungratified  libido  which  embraces  unconscious  complexes  and 
through  the  repression  of  these  gives  rise  to  neurotic  anxiety.  As 
the  mind  normally  reacts  to  impending  danger  from  without  by 
anxiety,  so  one  might  say  that  in  neurotic  anxiety,  the  ego  is 
defending  itself  against  internal  enemies.  In  these  cases,  we  have 
a  psychic  mechanism  which  is  identical  with  that  of  hysteria  ex- 
cept that  it  does  not  lead  to  conversion  into  physical  symptoms 
but  into  the  development  of  anxiety.  Anxiety  is  likewise  the 
only  symptom  into  which  the  psychic  excitement  is  converted  in 
this  case.  In  cases  as  they  occur  in  practice,  this  anxiety-hysteria 
may  be  mixed  in  any  degree  with  the  conversion-hysteria :  there 
may  be  conversion-hysteria  without  any  anxiety  as  well  as  pure 
anxiety-hysteria  which  expresses  itself  in  feelings  of  anxiety  and 
phobias.  Freud  has  already  in  his  work  on  anxiety-neurosis 
pointed  out  the  frequent  combination  of  hysteria  with  anxiety- 
neurosis.  This  is  explained  by  the  fact  that  very  often  besides 
the  somatic  diversion  of  the  libido,  a  part  of  the  same  may  strike 
back  to  the  unconscious  complexes  and  bring  these  to  life  again. 
It  is,  therefore,  not  chance  when  hysteria  and  anxiety-neurosis  so 
frequently  combine,  and  experience  shows  that  in  many  cases 
which  look  exactly  like  anxiety-neurosis  one  finds  a  bit  of  hysteria 
as  well.  In  this  sense,  Freud  says  anxiety-neurosis  may  be  called 
the  somatic  partner  of  hysteria.  Here  as  there,  is  an  accumula- 
tion of  excitation  in  which  perhaps  the  similarity  of  the  symptoms 
is  founded.  Here  as  there,  a  psychic  insufficiency  which  comes 
into  existence  in  consequence  of  abnormal  somatic  processes. 
Here  as  there,  in  place  of  mental  elaboration^  a  diversion  of  the 
ij_lliliiiii  iiilii  1I11  nnmil''-  ^rllffi  9la9e;  the  distinction  lies 
.in  the  fact  that  the  excitation,  in  the  displacement  ot  wliich 
the  jieurosis  iinds  HpiLSSiuii,  ij,  in  Uit  uuAiLl|  iiLUiumiupa  purely 


92  FREUD  S  THEORY  OF  THE   NEUROSES 

somatic  one  (the  snmptir  covimi  ovp;fo»v.or,fy  in  the  hysteria,  a 
psychic  one  (through  the  conflicts  aroused). 

Ihus,  there  is  an  hysterical  anxiety  which  is  psychically  divert- 
ible.  In  these  cases,  a  psychic  libidinous  excitation,  a  phantasy, 
suppressed  in  the  struggle  with  the  ego-instinct,  finds  its  way  back 
by  regression  to  pathogenic  infantile  unconscious  material  which, 
however,  is  not  converted  as  formerly  into  physical  symptoms, 
but  is  plainly  changed  in  a  way  prepared  in  infancy  into  anxiety. 
Neurotically  increased  anxiety  we  frequently  find  in  children. 
We  see  what  you  might  call  a  normal  anxiety  arise  in  them  in 
the  darkness  when  they  miss  the  beloved  person.  A  neurotic 
anxiety  arises  in  children  if  they  suddenly  come  in  contact  with 
the  sexual  problem  without  being  able  to  master  it  psychically. 
The  most  frequent  pathological  expression  of  this  anxiety  of 
children  is  the  pavor  nocturnus  as  the  foundation  for  which  a 
sexual  experience  in  the  broadest  sense  of  the  word  may  regularly 
be  proven.  When  one  searches  in  these  children  for  the  content 
of  their  horrible  dreams  or  phantasies  and  investigates  the  mean- 
ing of  what  you  might  call  the  somnambulistic  condition,  the 
repressed  material  regularly  appears.  The  most  frequent  neurosis 
of  childhood  is  anxiety-hysteria^^"  which  is  to  be  considered  in 
general  the  most  frequent  of  all  psychoneurotic  maladies.  As  an 
essential  characteristic  of  the  anxiety-hysteria  it  may  be  asserted 
that  it  always  tends  more  and  more  to  develop  a  phobia;  in  the 
end,  the  patient  may  become  free  from  anxiety  but  only  at  the 
price  of  inhibitions  and  limitations  to  which  he  must  submit.  In 
anxiety-hysteria,  from  the  begirming  on,  there  is  a  progressive 
psychic  attempt  to  join  the  free  anxiety  psychically  (to  something) 
but  this  work  can  neither  effect  the  reversion  of  this  anxiety  into 
libido  nor  join  it  to  the  same  complexes  from  which  the  libido  arose. 
There  remains  nothing  left  for  it  but  to  stop  every  possible  oppor- 
tunity for  the  development  of  anxiety  by  a  psychic  screen  of  a  kind 
of  foresight,  an  inhibition,  a  prohibition,  and  it  is  these  pro- 
tective structures  which  appear  to  us  as  phobias  and  constitute  the 
nature  of  the  malady  for  our  perception.  The  variety  of  this 
inhibition  whether  it  is,  for  example,  a  disturbance  of  gait  or  a 
disturbance  of  the  mouth  zone  (disturbance  of  eating  or  speak- 

"•  Compare  Freud's  "  Analyse  der  Phobic  eines  fiinf jahrigen  Knaben," 
Jahrb.,  I,  and  Jung,  "  Uber  Konflikte  der  kindlichen  Seele,"  Jahrb.,  II,  I. 


HYSTERIA  93 

ing),  etc.,  will  depend  on  what  organic  function,  constitutionally 
emphasized  and  erogenously  strengthened,  the  anxiety  attaches 
itself.  The  anxiety  leads  to  a  phobia,  you  might  say,  when  it 
gets  firmly  fixed  on  a  particular  complex.  The  most  frequent  of 
hysterical  phobias  is  the  agoraphobia  (Platzangst)  for  which  it 
is  characteristic  that  it  leads  to  no  absolute  inhibition  but  only  to 
preventing  the  patient  from  going  alone,  though  he  can  walk  when 
accompanied  by  specified  persons.  Often  an  attack  of  anxiety 
on  the  street  is  the  occasion  of  the  origin  of  the  agoraphobia;  the 
symptom  is  thus  constituted  to  prevent  an  outbreak  of  anxiety; 
the  phobia  is  erected  as  a  frontier  fortress  against  the  anxiety. 
At  the  bottom  of  the  agoraphobia  seem  to  be  various  sexual  and 
covetous  wishes  which  have  been  repressed  into  the  unconscious. 
These  are  mostly  erotic  desires  which  in  men  are  also  accom- 
panied by  covetous  phantasies.  The  symbolic  meaning  of  certain 
figures  of  speech  as  "to  bring  it  far,"  "to  come  to  something," 
"to  stand  on  your  own  feet,"  etc.,  frequently  play  an  overdetermin- 
ing  role ;  similarly  also  in  the  wish  "  to  go  through."  Recently, 
Freud  has  called  attention^^^  in  an  aphoristic  observation  to  the 
deeper  connections  of  such  cases  of  neurotic  disturbance  of  gait 
and  "  spatial  anxiety  "  to  the  original  pleasure  in  motion  of  chil- 
dren which  is  joined  to  sexual  excitations  and  voluptuous  sensa- 
tions. Another  anxiety-hysterical  disturbance  already  connected  / 
to  superficial  observation  with  sexual  etiological  agencies  is  the  \ 
erythrophobia  at  the  bottom  of  which  frequently  lies  the  self-  \  ^ 
reproach  of  shame  over  masturbation  or  the  experience  of  syphilis.^'->^^^\ 
Also,  premature  sexual  knowledge,  secretly  obtained  from  obser-^  \  Y^ 
vation  of  the  parents  and  imperfect  interpretation  of  this,  seem 
to  play  a  role.  Likewise,  feelings  of  being  slighted  and  anger  ma 
enter  in  (Adler).  If  this  anxiety  over  red  leads  to  inhibition 
in  the  life  activities,  for  example,  if  it  prevents  mingling  in  society, 
it  becomes  a  phobia. 

Concerning  vocational  anxiety-neuroses,  stage  fright,  examina- 
tion-anxiety, psychic  impotence  depending  on  anxiety,  etc., 
Stekel  has  sought  to  give  in  his  book  psycho-analytic  explanations 
with  detailed  casuistic  material. 

Without  the  meaning  of  neurotic  anxiety  as  having  originated 

*"  Concerning  muscular  activity  as  a  source  of  sexual  excitement  in 
childhood,  compare  "  Drei  Abhandlungen  zur  Sexualtheorie,"  Lit.  No.  20. 


94  freud's  theory  of  the  neuroses 

from  the  repression  of  libidinous  impulses,  the  anxiety-dream,  an 
almost  universal  experience,  which  is  also  a  frequent  symptom  of 
the  neurosis,  cannot  be  understood.  The  theory  of  the  anxiety 
dream  does  not  belong  to  the  problem  of  the  normal  dream  but  to 
the  anxiety  problem.  The  anxiety-dream  seems  at  first  to  con- 
tradict the  dream-theory  that  every  dream  represents  a  wish  ful- 
filled. When  one  has  clearly  shown,  however,  what  lurks  behind 
the  manifest  dream  content  of  the  anxiety-dream  and  penetrated 
to  the  latent  psychic  content,  the  objection  to  the  wish  theory  falls 
to  pieces.  The  interpretation  work  shows  that  the  anxiety  which 
we  feel  in  dreams  is  only  apparently  explained  by  the  content  of 
the  dream.  The  anxiety  is,  as  already  remarked,  only  attached  to 
the  accompanying  idea  and  springs  from  other  sources.  The 
interpretation  of  such  dreams  regularly  reveals  their  true  content 
to  be  a  repressed  sexual  wish,  the  distortion  of  which  in  the  dream 
has  failed.  To  the  breaking  through  of  the  sexual  in  the  dream 
which  is  also  apt  to  awaken  the  sleeper,  the  dreamer  can  only 
react  like  the  neurotic  in  waking  life,  namely,  by  anxiety.  In  this 
sense,  the  representation  of  the  unconscious  in  the  anxiety-dream 
would  be  an  especially  successful  one.  The  anxiety  in  these 
dreams  is  thus  mostly  a  psychoneurotic  one  arising  from  psycho- 
sexual  impulses  whereby  the  anxiety  corresponds  to  repressed 
libido.  Then,  this  anxiety  has,  like  the  whole  anxiety-dream,  the 
significance  of  a  neurotic  symptom  and  we  stand  on  the  boundary 
where  the  wish- fulfilling  tendency  of  the  dream  fails.^" 

Anxiety-dreams  are  of  frequent  occurrence  in  anxiety-neurosis 
and  anxiety-hysteria,  where  they  show  the  following  character- 
istic content.^^^  The  dream  picture  accompanied  by  anxiety  rep- 
resents the  patient  (usually  female)  oppressed  by  a  great  and 
dangerous  beast  which  threatens  to  throw  itself  on  the  dreamer; 
characteristically,  it  is  often  a  stallion  or  a  bull,  thus,  animals 
which  have  ever  stood  as  symbols  of  the  potent  strength  of  animal 
masculinity.  It  is  easy  to  see  in  these  animal  figures  the  symbol- 
ized givers  of  sexual  gratification  forbidden  by  conscious  thinking. 

***  In  other  anxiety-dreams,  the  feeling  of  anxiety  is  somatically  caused, 
as  for  example,  in  lung  and  heart  diseases  and  is  then  made  use  of  to  bring 
to  fulfillment  in  the  dream  of  suppressed  wishes  in  individuals  whose 
dreams  had  already  had  anxiety  from  psychic  motives. 

"'  Compare  in  this  connection  Ferenczi,  "  The  Psycho-analysis  of 
Dreams,"  Atner.  Jour.  Psychology,  Apr.,  1910,  as  well  as  Stekel's  cited  work. 


HYSTERIA  95 

A  still  plainer  symbolism  aiming  at  this  end  appears  in  dreams  of 
burglars  who,  armed  with  revolvers,  daggers  or  similar  instru- 
ments, press  in  upon  the  dreaming  lady.  The  starting  up  from 
sleep  because  of  such  anxiety-dreams,^^*  one  finds  frequently  in 
widows  and  ungratified  women  as  a  characteristic  kind  of  dis- 
turbance of  sleep.  Stekel"^  especially  emphasizes  the  dream  of 
the  death  of  the  child  who  stands  in  the  way  of  breaking  the  mar- 
riage or  prevents  the  divorce;  in  general,  dreams  of  death  and 
funerals,  especially  of  near  relatives,  are  typical  for  the  anxiety- 
neuroses. 

For  want  of  clinical  material,  Freud  had  relatively  little  oppor- 
tunity to  deal  with  the  outspoken  psychoses;  still,  he  considered 
these  within  the  scope  of  his  investigations.  The  few  cases  to 
which  he  himself  has  applied  the  insight  gained  from  the  psycho- 
neuroses  have  yielded  highly  important  disclosures  and  really 
incited  the  Zurich  clinic  to  splendid  work.  Through  the  dogma, 
insanities  are  brain  diseases,  and  through  scientific  work  chiefly 
devoted  to  nosography,  the  psychological  way  to  the  understanding 
of  the  psychoses  was  little  used.  Freud  joined  Griesinger  who 
ascribed  to  the  psychic  causes  the  predominant  role  in  the  causa- 
tion of  the  psychoses.  Freud  divided  the  cases  analyzed  by  him- 
self into  "overpowering  psychoses"  and  "defence-psychoses." 
Under  the  former,  he  classed  those  cases  in  which  the  unconscious 
had  completely  and  violently  overcome  the  conscious.  Freud  re- 
ported one  such  case,  met  with  in  the  course  of  an  hysteria,  of  an 
hallucinatory  confusion  (of  which  he  had  seen  a  few)  in  which 
the  person  (in  sense  of  Griesinger)  represented  the  fulfillment  of 
her  repressed  wishes  in  hallucinatory  manner,  while  she  awaited 
in  vain  an  appointed  day  with  her  lover,  suddenly  had  hallucina- 
tions, hastened  to  meet  him,  greeted  him  and  for  two  months 
lived  in  the  happy  dream  that  he  was  there,  always  near  her,  etc. 
Thus,  the  patient  has  warded  off  the  unbearable  idea  of  remaining 
away  from  a  longed-for  lover  in  energetic  and  in  a  certain  sense, 

***  Recently  Ernest  Jones  has  sought  to  elucidate  the  nightmare  from 
Freudian  standpoint,  "  On  the  Nightmare,"  Amer.  Jour.  Insanity,  Jan., 
1910. 

"*This  repressed  wish  can  express  itself  as  an  obsessional  impulse 
to  injure  or  kill  the  child.    Compare  Lit.  No.  6. 


96  freud's  theory  op  the  neuroses 

successful  manner,  while  the  ego  rejects  the  unbearable  idea 
together  with  its  affect  and  behaves  as  if  the  idea  had  never 
occurred  to  it.  But  in  the  moment  in  which  this  succeeded,  the 
person  is  already  in  a  psychosis  which  one  can  classify  only  as 
hallucinatory  confusion.  Thus,  the  ego  tears  itself  loose  from  the 
unbearable  idea;  this  is  inseparably  connected  with  a  piece  of 
reality  however,  and  while  the  ego  accomplishes  this  task,  it  has 
separated  itself  in  whole  or  in  part,  from  reality.  According  to 
Freud,  this  is  the  condition  in  which  hallucinatory  vivacity,  amid 
its  own  ideas,  is  to  be  judged. 

In  contrast  to  this  overcoming  en  masse,  the  analogy  to 
hysteria  in  the  defence-psychoses  (paranoia,  dementia  paranoides) 
is  complete  so  that  in  the  initial  stages  of  these  cases,  they  often 
cannot  be  sharply  differentiated  from  hysteria  and  other  neuroses. 
In  these  cases  of  defence-psychosis,  the  whole  previous  history, 
course  of  development,  genesis,  complexes  and  infantile  repres- 
sion are  the  same  as  in  cases  of  hysteria.  It  seems  that  the  differ- 
ent clinical  pictures  of  the  defence-psychoses  are  characterized 
only  by  different  repression  mechanisms  which  come  into  play 
later,  concerning  which,  however,  nothing  definite  is  known.  The 
libido  may  have  suffered  a  quite  special  fate  in  this.  Thus,  in 
dementia  praecox,  there  seems  to  be  a  characteristic  withdrawal 
of  the  libido — the  term  taken  in  its  broadest  sense — from  the 
objects  of  the  external  world.  Therein,  lies  an  exquisite  contrast 
to  hysteria  to  which  Abraham  has  referred.^^"  While  in  hysteria 
there  is  much  free  floating  libido  for  the  use  of  the  object,  in  cer- 
tain cases  of  the  psychosis  it  seems  to  be  fastened  to  the  ego 
complex  and  thus  leads  to  ideas  of  grandeur.  Thus  is  also 
explained  the  inner  connection  between  persecution  mania  and 
delusions  of  grandeur  in  the  paranoiad  forms. 

Freud  has  described  in  detail  a  case  of  hallucinatory  para- 
noia^^'^  analyzed  by  him,  in  which  he  shows  that  a  group  of  cases 
which  belong  to  paranoia  arise  just  like  hysteria  and  the  obses- 
sional neurosis  from  the  repression  of  painful  memories  and  that 
the  symptoms  of  these  are  determined  in  form  by  the  content  of 
the  repressed  material.      Further,  in  this  case,  the  repressed 

"• "  Die  psychosexuellen  DifFerenzen  zwischen  Hysteric  und  Dementia 
praecox,"  Zentralhlatt  f.  Psych,  u.  Neurol.,  July,  1908. 

***  Perhaps  more  correctly  called  dementia  paranoides.    Lit.  No.  3. 


HYSTERIA 


97 


material  was  revealed  as  a  sexual  experience  of  childhood 
(phantasy),  the  content  of  which,  however,  does  not  have  to  be 
recovered  by  the  tedious  way  of  analytic  interpretation  work  but 
which  the  patient,  as  in  all  cases  of  paranoia,  expressed  quite 
undisguised.  In  paranoia,  much  pushes  into  consciousness  which 
we  proved  to  exist  in  the  unconscious  of  normal  and  neurotic 
individuals  only  by  psycho-analysis.  Thus,  the  phantasies  of 
hystericals  which  have  to  be  made  conscious  by  analysis  hide 
themselves  from  sexual  and  cruel  maltreatment,  for  example, 
occasionally  as  far  as  in  individual  cases  the  complaint  of  para- 
noiacs,  "  persecuted."  It  is  worthy  of  note,  but  not  incomprehen- 
sible in  the  light  of  the  Freudian  sexual  theory,  that  the  identical 
content  meets  us  as  reality  in  the  arrangements  of  perverts  for 
the  gratification  of  their  appetites. 

For  the  periodic  melancholia,  Freud  asserts  that  these  cases 
appear  to  dissolve  in  unexpected  frequency  into  obsessional  ideas 
and  obsessional  affects,  a  perception  which  is  not  of  indifferent 
importance  therapeutically.  The  individual  attack  of  ill  humor 
may  be  favorably  influenced  psycho-analytically  even  if  further 
attacks  may  not  always  be  prevented. 

In  this  relatively  small  casuistry  Freud  has  been  able  to  show 
that  sense  and  logic  may  be  demonstrated  in  delusions,  as  also  in 
the  peculiar  variety  of  unconscious  thinking,  and  has,  thereby, 
brought  the  cause  and  content  of  mental  disturbances  into  psycho- 
analytic investigation.  The  Zurich  school,  with  Jung  at  its  head, 
has  busied  itself  according  to  the  clinical  material  at  its  command, 
with  especial  attention  to  dementia  prsecox.  Jung's  painstaking 
labors  in  the  analysis  of  every  expression  of  a  very  averse  dement 
succeeded  in  showing  the  same  psychic  mechanisms  which  Freud 
had  found  in  the  neuroses  also  present  here  in  demonstrable  form, 
so  that  no  more  doubt  can  exist  that  at  the  bottom  of  dementia 
praecox  lies  a  repressed  erotic  complex,^^*  The  dulling  of  the 
affect  is  only  apparent  and,  according  to  Jung,  explained  by  its 
absorption  by  the  ruling  complex.^^^  The  psycho-analytic  study 
of  these  conditions  has  yielded  still  more.     It  showed  that  the 

"*Jung,  "Uber  die  Psychologic  der  Dementia  praecox."  K.  Marhold, 
Halle,  1907. 

'^"  Compare  also  Bleuler-Jung,  "  Koraplexe  als  Krankheitsursachen  bei 
Dementia  praecox,"  Zentralb.  f.  N ervenheilkunde  u.  Psychiatric,  1908. 

8 


98  freud's  theory  of  the  neuroses 

apparently  absurd  symptoms  of  dementia  prgecox  prove  on 
analytic  investigation  to  be  symbolic  figures  of  intelligible  and,  in 
the  mental  life  of  the  person,  highly  important  trains  of  thought 
and  impulses.^^"  Abraham  has  brought  out,  beside  the  article 
already  mentioned  on  the  withdrawal  of  the  libido  from  the 
external  world  which  is  so  especially  characteristic  of  dementia 
praecox,  also  another  article  on  the  significance  of  dreams  of 
youth  for  the  symptomatology  of  dementia  praecox  ;^^^  Maeder^^* 
has  dealt  in  detail  with  the  delusional  structures  of  the  paranoiad 
conditions.  Riklin  published  a  "  contribution  to  the  psychology  of 
cataleptic  conditions  in  catatonia."^^*  Freudian  mechanisms  could 
also  be  shown  in  various  other  psychoses.  Thus  Bleuler,^^*  in  his 
work  on  "  Freudian  mechanisms  in  the  symptomatology  of  the 
psychoses,"  furnished  a  series  of  interesting  examples.  Otto 
Gross  considered  "the  Freudian  idiogenesis  agency  and  its  sig- 
nificance in  manic  depressive  insanity  of  Kraepelin"  (Leipzig, 
1907).  In  this  work  appears  also  a  reference  to  the  psycho- 
genesis  of  kleptomania.^^^  Finally,  there  follows  a  short  reference 
to  some  published  works  of  Jung:  "A  Case  of  Hysterical  Stupor 
in  a  Prisoner  Under  Trial,"  further  "  Concerning  Simulation  of 
Insanity."^^"  On  the  psychology  of  hysterical  twilight  states, 
Riklin"'^  and  Schwarzwald"*  have  published  contributions.  "  On 
Obsessional  Psychoses  "  Warda^^®  has  written.    Stekel  has  under- 

"•Jung,  "Der  Inhalt  der  Psychose,"  Schr.  z.  angew.  Seelenkunde,  3, 
1908. 

^  Zentralblatt  fur  Nervenheilkunde  und  Psychiatric,  1907. 

^ "  Psychologische  Untersuchungen  an  Dementia  praecox-Kranken," 
Jahrb.,  II,  i,  1910. 

"*  Riklin,  "  Beitrag  zur  Psychologie  der  kataleptischen  Zustande  bei 
Katatonie,"  Psychiatr.-Neurol.  Wochenschr.,  1906,  No.  32. 

^  Bleuler,  "  Freudsche  Mechanismen  in  der  Symptomatologie  der  Psy- 
chosen,"  Psychiatr.-Neurolog.  Wochenschr.,  1906,  Nos.  35-36. 

^  Compare  also  Stekel,  "  Die  sexuelle  Wurzel  der  Kleptomanie,"  Zeit- 
schrift  f.  Sexualwissenschaft,  1st  year. 

^  Jung,  "  Ein  Fall  von  hysterischen  Stupor  bei  einem  Untersuchungs- 
gefangenen,"  and  "  t)ber  Simulation  von  Geistesstorung,"  Journal  f.  Psy- 
chologie u.  Neurologic,  1902  and  1905. 

^Psychiatr.-Neurolog.  Wochenschrift,  1904. 

^^  Journal  f.  Psychologie  u.  Neurologic,  1909. 

"•Warda,  "Uber  Zwangsvorstellungspsychosen,"  Monatsschr.  f.  Psy- 
chiatric und  Neurologic,  1902. 


HYSTERIA  99 

taken  an  analysis  of  a  case  of  melancholia.^^"  Jones  reports  on  a 
case  of  hypomania/^^  Maeder^^^  on  a  psycho-analysis  of  a  melan- 
cholic depression  and  Riklin^^^  on  prison  psychoses. 

From  this  enumeration,  which  does  not  pretend  to  be  complete, 
it  may  be  recognized  how  much  promise  for  psychiatry  is  held 
out  by  the  Freudian  theory  of  the  neuroses. 

""  Compare  "  Die  Angstzustande." 

^ "  Psycho-analytic  notes  on  a  case  of  hypomania,"  Amer.  Jour.  In- 
sanity, 1910. 

"^ "  Eine  Psychoanalyse  bei  einer  melancholischen  Depression,"  Zentral- 
blatt  f.  Neurologic  u.  Psychiatric,  1910,  page  50. 

^^  tlber  Gefangnispsychosen,"  Psychiatri.-Neurol.  Wochenschr.,  1909. 


^ 


CHAPTER   VII 

THE  OBSESSIONAL  NEUROSIS 

Relation  to  Hysteria.  Substitution  Instead  of  Conversion.  Charac- 
teristic Obsession.  "  Nature  and  Mechanism  of  the  Obsessional  Neu- 
rosis" (1896).  "Remarks  on  a  Case  of  Obsessional  Neurosis"  (1909). 
Significance  of  Instinct  in  Life  (Sadism).  Love  and  Hate;  Obsession 
and  Doubt.  Mechanism  of  Distortion.  Some  Mental  Peculiarities  of 
the  Obsessed. 

As  a  result  of  Freud's  work,  the  obsessional  neurosis  has 
received  an  important  elucidation  and  the  treatment  of  this  afflic- 
tion, which  is  often  so  severe  as  to  undermine  every  happiness  of 
life,  seems  to  warrant  a  much  better  prognosis.  To  be  sure,  those 
suffering  from  this  neurosis,  the  symptoms  of  which  often  appear 
in  childhood,  must  come  under  treatment  early.  The  explanation 
of  this  complicated  clinical  picture  is  accompanied  by  much 
greater  difficulties  than  the  interpretation  of  hysteria,  and  Freud 
himself  admits  that  even  he  has  not  yet  succeeded  in  completely 
elucidating  a  case  of  obsessional  neurosis ;  still,  there  has  recently 
appeared  a  most  illuminating  work  by  Freud  which  utilizes  the 
results  of  his  investigations  during  the  past  years,  especially 
regarding  the  nuclear-complex  and  instinctive  life,  in  explaining 
a  case  of  obsessional  neurosis. 

In  the  exposition  of  the  theory  of  the  psychoneuroses,  the 
fact  has  already  been  repeatedly  mentioned  and  emphasized  that 
the  presuppositions  of  the  obsessional  neurosis  are  in  part  the 
same  as  in  hysteria  and  that  their  origin  likewise  rests  on  the 
unsuccessful  repression  of  psycho-sexual  factors.  The  differ- 
ences are  due  to  the  fact  that  here  a  different  repression  mechan- 
ism and,  because  of  the  breaking  through  of  repressed  material, 
a  different  kind  of  symptom  formation  comes  into  existence.  The 
affect  of  the  painful  idea  does  not  become  transformed  into 
physical  symptoms  as  in  hysteria  (conversion),  but  affixes  itself 
to  other  ideas,  not  in  themselves  unbearable,  thus  producing  by 
this  false  relationship,  obsessions  (substitution).  Characteristic 
of  obsessive  ideas  and,  in  a  broader  sense,  of  obsessive  mental 

100 


THE  OBSESSIONAL   NEUROSIS  lOI 

processes  in  general,  is  that  paradoxical  feeling  of  compulsion  or 
obsessiveness  (Zwang)  in  which  absurd  or  quite  harmless  ideas 
stand  in  the  foreground  of  consciousness  and  resist  dislodgment 
by  logic,  even  proving  completely  refractory  to  it.  This  arises 
from  the  fact  that  the  contents  of  these  obsessive  mental  processes 
are  only  false  labels,  carriers  of  affects  which  do  not  really  belong 
to  them.  Conscious  logical  effort  exerts  itself  in  vain  inasmuch 
as  it  only  reaches  a  sphere  of  mental  activity  where  it  can  accom- 
plish no  useful  end.  The  displacement  of  the  affect  onto  the  sub- 
stituted idea  thus  attains  the  end  of  making  the  real  connection 
unrecognizable  and  the  work  of  logic  fruitless.  Only  when  by 
the  aid  of  psycho-analysis  the  true  relation  of  the  obsessive  ideas 
to  the  infantile  material  is  made  conscious  can  the  obsession  be 
removed.  The  analytic  therapy  proceeds,  therefore,  upon  the 
following  assumption,  which  is  also  demonstrable  elsewhere  in 
mental  life:  where  there  occurs  a  mesalliance  between  an  idea 
and  an  affect,  hence  between  the  intensity  of  a  self-reproach,  for 
example,  and  the  occasion  for  the  reproach,  the  laity  would  say 
that  the  affect  is  too  strong  for  the  occasion,  hence  excessive  and 
the  deduction  drawn  from  the  reproach  is  therefore  false.  The 
psycho-analyst,  on  the  contrary,  has  to  say:  no,  the  affect  is  justi- 
fied, the  consciousness  of  guilt  is  not  to  be  criticized;  it  belongs 
to  another,  unknown  (unconscious)  content  which  must  be 
uncovered. 

J^s  already  mentioned,  infantilism  and  sexuality  possess  a  fun- 
damental etiological  significance  for  the  obsessional  neurosis  as 
vvell  as  for  hysteria,  although  in  the  obsessional  condition  these 
exhibit  certain  peculiarities.  The  sexual  activities  of  childhood 
are  manifested  in  a  particularly  active  manner;  without  exception, 
these  are  children  who  even  in  early  life  betray  very  intense 
aggressiveness.  In  contrast  to  hysteria,  this  characteristic  of 
precocious  sexual  activity  is  absent  in  no  case  of  obsessional 
neurosis.  With  this  difference  is  connected  another,  namely,  that 
in  this  neurosis  the  male  sex  seems  to  have  the  preference.  In 
general,  the  obsessional  neurosis  shows  much  more  clearly  than 
hysteria  that  the  agents  causing  the  neurosis  are  to  be  sought,  not 
in  the  actual  but  in  the  infantile  sexual  life.  The  necessary 
infantile  basis  of  the  obsessional  neurosis,  in  distinction  to  that 
of  hysteria,  is  not  always  completely  lost  in  amnesia ;  in  particular, 


102  FREUD  S   THEORY   OF  THE   NEUROSES 

the  idea  which  is  separated  from  its  affect  is  frequently  present 
and  treated  as  of  no  consequence  by  the  patient's  consciousness. 
Etiologically,  these  two  neuroses  stand  close  together  and  fre- 
quently appear  in  combination.  At  the  bottom  of  an  obsessional 
neurosis,  the  analysis  often  reveals  a  bit  of  hysteria. 

The  first  detailed  work  of  Freud's  on  the  obsessions^'*  con- 
tains the  most  important  features  of  the  analysis  of  this  clinical 
picture  but  was  later  found  by  Freud  himself  to  require  improve- 
ment in  certain  particulars.  Nevertheless,  for  the  student,  this 
work,  because  of  its  schematic  presentation  of  this  clinical  picture 
with  its  most  complicated  psychology,  is  an  especially  good  guide. 

According  to  Freud's  original  exposition,  the  typical  course 
of  a  case  of  obsessional  neurosis  would  be  something  as  follows : 
In  a  first  period — period  of  childish  immorality — the  events  con- 
taining the  seed  of  the  later  neurosis  occur.  In  earliest  childhood, 
the  acts  of  sexual  aggression  take  place  against  the  other  sex 
which  later  appear  in  actions  symbolizing  reproach.  This  period 
is  brought  to  an  end  by  the  appearance  of  sexual  maturity,  often 
self-induced.  Now  a  reproach  becomes  joined  to  the  memory  of 
those  sensual  acts,  this  is  repressed  and  replaced  by  a  primary 
defence  symptom.  Scrupulousness,  shame,  self-distrust  are  such 
symptoms,  with  which  the  third  period,  that  of  apparent  health 
but  really  successful  defence,  begins. 

The  next  stage,  that  of  actual  sickness,  is  characterized  by 
the  return  of  the  repressed  material,  that  is,  by  the  failure  of 
the  defence.  The  revived  impulses  and  memories  as  well  as  the 
reproaches  formed  from  them  penetrate  consciousness  but  never 
in  unchanged  form,  always  as  obsessive  idea  and  obsessive  affect 
and  the  pathogenic  memory  substituted  for  the  conscious  life; 
thus  are  formed  compromise  formations  between  the  repressed 
and  repressing  ideas,  so  that  the  repressing  material  may  again 
be  identified  in  the  symptoms  alongside  some  of  the  repressed. 

In  the  further  course  of  the  development  of  the  neurosis  two 
forms  of  the  disease  can  be  differentiated  according  as  only  the 
memory  content   of   the   act   symbolizing   reproach    forces    an 

''*"Weitere  Bemerkungen  iiber  die  Abwehr-Neuropsychosen  "  (1896), 
Lit.  No.  8.  Earlier  compare  under  "Die  Abwehrneuropsychosen "  (1894), 
Lit.  No.  53.  "Obsessions  et  phobies;  leur  mecanisme  psychique  et  leur 
etiologie"  (1895),  Lit.  No.  6. 


THE  OBSESSIONAL   NEUROSIS  IO3 

entrance  into  consciousness  or  is  accompanied  by  the  reproach- 
affect.  The  first  case  is  that  of  the  typical  obsession  in  which  the 
content  attracts  the  patient's  attention  accompanied  by  only  an 
indefinite  feeling  of  discomfort  as  affect,  whereas  only  the  affect 
of  reproach  would  be  suitable  for  the  content  of  the  obsessive  idea. 
In  the  second  form  of  obsessional  neurosis  the  reproach-affect 
can,  by  a  psychic  addition,  change  itself  into  any  other  unpleasant 
affect;  if  this  has  happened,  then  nothing  more  stands  in  the  way 
of  the  substituted  affect's  becoming  conscious.  Thus  the  reproach 
(of  having  carried  out  some  sexual  acts  in  childhood)  is  easily 
changed  into  shame  (if  another  becomes  aware  of  it),  into  hypo- 
chondriacal anxiety  (because  of  the  injurious  physical  conse- 
quences of  those  reproachful  acts),  into  social  anxiety  (fearing 
punishment  by  society  for  that  offense),  into  religious  anxiety, 
into  the  delusion  of  being  observed  (fear  of  betraying  those  acts 
to  others),  into  fear  of  being  tempted  (justified  distrust  in  their 
own  power  of  resistance)  and'  so  on.  Therewith,  the  memory 
content  of  the  act  symbolizing  reproach  can  be  present  in  con- 
sciousness or  entirely  absent,  which  greatly  complicates  the 
diagnostic  difficulties.  Many  cases  which  a  superficial  examina- 
tion calls  general  (neurasthenic)  hypochondria  belong  to  this 
group  of  obsessive  affects;  especially  do  the  so-called  "periodic 
neurasthenia"  or  "periodic  melancholia"  (cyclothymia)  seem  in 
unexpected  frequency  to  resolve  into  obsessive  affects  or  obsessive 
ideas,  a  perception  which  is  not  of  slight  therapeutic  importance. 
Besides  these  compromise  symptoms  which  signify  the  return 
of  the  repressed  material  and  thereby  a  failure  of  the  originally 
achieved  defence,  the  obsessional  neurosis  forms  a  series  of  other 
symptoms  of  a  totally  different  origin.  The  ego  seeks  to  defend 
itself  against  those  descendants  of  the  initial  repressed  memory, 
and  in  this  conflict  produces  symptoms  which  Freud  has  grouped 
together  under  the  name  "  secondary  defence."  These  are  without 
exception  protective  measures  which  have  performed  good  service 
in  the  struggle  against  the  obsessions  and  obsessive  affects.  If 
these  aids  in  the  defence  process  really  succeed  in  repressing  a«ew 
the  symptoms  of  the  return  of  the  memories  originally  repressed 
by  the  ego,  then  the  obsession  is  transferred  to  the  protective 
measures  themselves  and  produces  a  third  form  of  obsessional 
neurosis,  the  obsessive  acts.     These  seem  to  be  seldom  primary; 


^ 


104  FREUD'S  THEORY   OF   THE   NEUROSES 


they  never  contain  anything  except  a  defence,  never  an  aggres- 
sion. Psycho-analysis  demonstrates  that  in  spite  of  their  peculi- 
arity and  diversity,  these  acts  in  every  case  may  be  fully  explained 
in  this  manner.  It  is  found  that  these  obsessive  acts,  which  often 
seem  so  silly  and  senseless,  have  a  meaning  in  all  of  their  pecu- 
liarities without  exception;  they  serve  the  most  vital  interests  of 
the  personality  and  bring  to  expressions^"  experiences  which  are 
still  active  as  well  as  thoughts  tinged  with  affects  from  the  latter ; 
this  is  effected  by  direct  or  symbolic  representation.  The  obses- 
sive acts  are,  therefore,  to  be  interpreted  either  as  historical  or 
symbolic. 

The  secondary  defence  of  the  obsessions  can  be  accomplished 
by  a  strange  diversion  to  other  thoughts  of  possibly  contrary  con- 
tent ;  hence  in  case  of  success,  the  obsessive  reasoning  is  regularly 
concerned  with  abstract  and  transcendental  subjects,  because  the 
repressed  ideas  always  occupied  themselves  with  sensuality.  Or 
the  patient  attempts  to  become  master  of  each  individual  obsessive 
idea  by  force  of  logic  and  appeal  to  his  conscious  memories ;  this 
leads  to  obsessive  thinking,  obsessive  testing  and  doubting  mania. 
In  these  testing  measures,  the  superior  power  of  the  obsessive  idea 
over  the  actual  memory  at  first  impels  the  patient  and  later  com- 
pels him  to  collect  and  preserve  all  objects  with  which  he  comes 
in  contact.  The  frequently  grotesque  and  quite  unintelligible 
content  of  the  obsessions  is  made  clear  by  the  explanation  that 
these  ideas,  in  contrast  to  the  content  of  obsessional  acts  of  child- 
hood, are  distorted  in  a  twofold  manner:  (i)  An  actual  occur- 
rence is  put  in  the  place  of  a  past  experience;  (2)  something 
sexual  is  replaced  by  something  analogous  non-sexual,  both 
processes  due  to  the  ever-present  tendency  to  repression.  This 
displacement  onto  another  idea  goes  forward  only  gradually  as 
the  idea  becomes  little  by  little  more  disparate  and  unrecognizable. 
The  obsession  finally  appears,  devoid  of  motive  and  senseless, 
quite  like  the  wording  of  our  nocturnal  dreams,  and  the  first 
task  which  it  imposes  is  to  give  them  meaning  and  position  in  the 
mental  life  of  the  individual,  so  that  they  may  become  intelligible 
and  indeed  even  obvious. 

**  According  to  a  later  statement  of  Freud's,  the  unconscious  model 
for  certain  obsessive  acts  which  is  always  imitated  in  the  course  of  the 
disease  may  be  the  original  sexual  act  which  was  later  repressed.  Lit. 
No.  36. 


THE   OBSESSIONAL    NEUROSIS  IO5 

The  secondary  defence  against  the  obsessive  affects  develops 
a  still  longer  series  of  protective  measures,  which  are  readily- 
changeable  into  obsessive  acts.  These  can  be  grouped  according 
to  their  tendencies :  penitential  measures,  irksome  ceremonials, 
observation  of  numbers,  measures  of  protection  (all  kinds  of 
phobias,  superstitions,  pedantry,  aggravation  of  primary  symp- 
toms of  scrupulousness),  fear  of  betrayal  (paper-collecting, 
diffidence),  narcotization  (dipsomania).  Among  these  obsessive 
acts  and  impulses,  the  phobias  play  the  greatest  role  in  restricting 
the  life  activities  of  the  patient.  The  phobias  which  appear  in  the 
course  of  an  obsessional  neurosis  are  the  expression,  not  of  fears 
but  of  prohibitions. 

To  give  a  systematic  and  well-rounded  exposition  of  the  obses- 
sional neurosis  on  the  basis  of  Freud's  works  is  impossible ;  only 
recently,  his  first  publication  has  been  succeeded  by  a  second  which 
brings  out  much  that  is  entirely  new  and  valuable,  though  only 
devoted  to  the  exposition  of  a  single  case  of  severe  obsessional 
neurosis  without  pretending  to  have  elaborated  an  exhaustive  or 
universally  applicable  theory  of  the  subject.  For  a  presentation 
which  is  intended  to  be  merely  a  summary,  the  long  interval 
between  the  two  works  as  well  as  the  differences  in  their  content 
are  well  suited  to  illustrate  the  important  progress  and  growing 
depth  of  the  Freudian  doctrines.  These  "  Remarks  on  a  Case  of 
Obsessional  Neurosis  "^^*  (1910)  give  extracts  from  a  detailed 
analysis  of  a  common  type  of  severe  obsessional  neurosis  and,  in 
accordance  with  the  modern  status  of  the  theory,  trace  the  etiol- 
ogy in  widest  measure  to  infantile  sexual  life  and  instinct,  at  the 
same  time  showing  in  particular  the  connection  of  the  obsessional 
neurosis  to  the  sadistic  component  of  the  sexual  instinct.  In  addi- 
tion, the  new  work  contains  statements  on  the  genesis  and  finer 
mental  mechanism  of  obsessive  thought  in  general,  communica- 
tions which,  since  they  bear  on  the  exposition  of  the  psycho- 
genesis  of  the  obsessions  thus  far  given,  will  be  reviewed  first. 

In  his  first  work,  Freud  had  defined  obsessions  in  the  broadest 
sense  collectively  in  the  following  words:  they  are  in  every  case 
transformed  reproaches  which  have  escaped  from  the  repression 
and  are  always  connected  with  some  pleasurably  accomplished 

"•Lit.  No.  36. 


io6  freud's  theory  of  the  neuroses 

sexual  act  of  childhood.  This  definition  is  not  discarded  in  the 
later  work  but  the  greatest  accent  is  placed  on  the  word  "  trans- 
formed." Freud's  most  recent  work  now  goes  into  the  manner 
and  mechanism  of  this  transformation  in  exhaustive  and  detailed 
fashion  with  special  attention  to  the  psychological  refinements  in 
the  formation  of  the  neurosis.  Freud  starts  by  asserting  that  it  is 
more  correct  to  speak  of  obsessive  thinking  than  of  obsessive  ideas 
(obsessions),  at  the  same  time  emphasizing  the  fact  that  the  obses- 
sional structure  may  have  the  value  of  the  most  diverse  kinds  of 
mental  processes.  They  may  be  felt  as  wishes,  temptations,  im- 
pulses, reflexions,  doubts,  commands  and  prohibitions.  The 
patients,  however,  strive  in  general  to  weaken  this  definiteness 
and  to  consider  the  thought-content  robbed  of  its  affect-index 
only  as  a  mental  process,  as  an  obsession.  When  a  psycho-analyst 
comes  into  opposition  to  a  person  suffering  from  such  an  obses- 
sional neurosis,  there  appears  as  already  mentioned  the  paradox- 
ical emotion  of  obsessive  force  attached  to  a  very  indifferent 
content  and  it  is  only  after  much  effort  that  he  succeeds  in  pene- 
trating to  the  original  content  to  which  this  affect  rightly  belongs. 
The  mechanism  and  distortion  which  the  patient  has  brought  into 
use  in  this  defence  conflict  are  not  so  simple  as  originally  thought. 
The  value  of  the  correctly  recognized  distinction  between  primary 
and  secondary  defence  conflict  becomes  limited  in  an  unexpected 
manner  by  the  discovery  that  the  patients  for  the  most  part  do  not 
know  the  wording  of  their  obsessions  and  only  in  the  psycho- 
analytic treatment  become  aware  of  their  true  meaning,  especially 
by  the  aid  of  dreams.  During  the  analytic  investigation  of  the 
patient's  history,  the  conviction  is  forced  upon  one  that  the  obses- 
sions which  appear  successively,  although  not  expressed  in  iden- 
tical language,  are  at  bottom  one  and  the  same.  The  obsession 
which  has  been  happily  gotten  rid  of  once  now  returns  again  in  a 
more  distorted  form.  The  original  form  is  the  correct  one, 
which  often  allows  its  meaning  to  be  clearly  recognized.  After 
one  has  patiently  worked  out  an  unintelligible  obsessive  idea,  he 
often  hears  the  patient  say  that  such  a  temptation,  idea  or  wish 
really  did  appear  at  one  time  before  the  obsessive  idea,  but  did 
not  remain.  The  typical  characteristic  obsession  carries  thus  in 
its  distortion  against  its  original  wording  traces  of  the  primary 
defence  conflict.    The  distortion  allows  them  to  find  expression 


THE   OBSESSIONAL   NEUROSIS  lO/ 

by  compelling  consciousness  to  misunderstand  them,  just  as  the 
dream  content,  which  is  likewise  a  compromise  and  distortion 
product,  is  misunderstood  by  the  waking  consciousness.^^'^ 

The  distortion  makes  use  of  various  mechanisms.  The  sim- 
plest is  the  distortion  through  ellipse,  which  finds  such  special 
application  in  wit,^^*  but  also  does  duty  in  the  neurosis  as  a  means 
of  protection  against  the  correct  recognition  of  the  obsessive  idea. 
One  of  the  favorite  obsessive  ideas  of  the  patient  whom  Freud 
took  as  paradigma  in  his  publication  is  expressed  as  follows :  "  If 
I  marry  Madame  X  misfortune  will  befall  my  father  (in  the  other 
world)."  If  we  insert  the  connecting  links  which  are  omitted  in 
this  expression  and  only  brought  to  consciousness  by  the  analysis, 
the  train  of  thought  takes  a  more  intelligible  form :  "  If  my  father 
were  alive,  he  would  become  greatly  enraged  over  my  intention  of 
marrying  Madame  X,  just  as  he  did  that  time  he  flogged  me  as  a 
child,  and  I  would  again  be  angry  at  him  and  wish  him  all  evil, 
which  the  omnipotent  power  of  my  wishes  cannot  help  bringing  to 
fulfillment  upon  him."  This  elliptical  distortion  technique  seems 
to  be  typical  for  the  obsessional  neurosis.  Alongside  the  distor- 
tion which  the  obsessive  thought  has  undergone  before  becoming 
conscious,  there  is  seldom  lacking  a  separation  of  the  individual 
obsessive  idea  from  the  occasion  of  its  origin  in  which  in  spite  of 
the  distortion  it  would  be  most  easily  accessible  to  the  understand- 
ing. In  furtherance  of  this  purpose,  an  interval  is  interposed 
between  the  pathogenic  occasion  and  the  resulting  obsessional 
idea  which  leads  consciousness  astray  in  its  search  for  a  cause 
and  correspondingly  disturbs  the  interpretation  of  the  obsessional 
idea  when  it  is  again  attempted  to  ascertain  its  temporal  relation- 
ship to  the  event  in  the  experience  of  the  patient  by  discovering 
when  the  individual  obsessive  idea  first  appeared  and  under  what 
external  circumstances  it  usually  reappears.  In  addition  to  this 
temporal  displacement,  the  content  of  the  obsessive  idea  is  almost 
regularly  freed  from  its  special  relations  by  generalization.  In 
this  connection,  Freud  brings  forward,  as  an  example,  a  patient 
who  had  the  obsessive  prohibition  of  wearing  any  jewelry  what- 

""This  misunderstanding  by  consciousness  is  observable  not  only  in 
the  obsessive  idea  itself  but  also  in  the  products  of  the  secondary  defence 
conflict,  for  example,  in  the  protective  measures. 

'**  Compare  Freud's  "  Der  Witz,  etc.,"  Lit.  No.  19. 


/ 


lo8  freud's  theory  of  the  neuroses 

ever,  although  the  occasion  for  the  prohibition  went  back  to  a 
particular  piece  of  jewelry  which  she  had  envied  her  mother  and 
which  she  hoped  would  one  day  come  to  her  by  inheritance.  A 
further  frequent  characteristic  of  the  mental  processes  of  the 
obsessional  neurosis  is  the  mechanism  of  displacement  which 
Freud  first  discovered  in  the  dream  formation  and  later  proved 
to  be  also  an  essential  factor  of  the  technique  of  wit.  Especially 
in  the  obsessive  acts  is  it  most  evident  how  by  a  dfisplacement 
from  the  thing  of  real  importance  onto  a  substitute  of  little  im- 
portance, the  symbolism  and  detail  of  the  process  (the  cere- 
monial) come  to  expression.  It  is  this  tendency  to  displacement 
which  is  constantly  changing  the  clinical  picture  of  the  disease 
and  finally  succeeds  in  making  the  apparently  most  trivial  things 
seem  the  weightiest  and  most  urgent. 

Finally,  one  can  separate  from  the  distorted  content  the  am- 
biguous and  indefinite  wording  which  serves  as  a  protection  of 
the  obsessive  idea  against  the  conscious  attempt  to  solve  it.  The 
further  amplifications  or  replacements  by  the  obsessive  force 
become  joined  to  this  misunderstood  wording  instead  of  to  the 
correct  context.  These  processes,  in  contrast  to  the  distortion 
technique  of  the  content,  belong  to  the  secondary  defence  conflict, 
the  symptomatology  of  which  receives  a  new  increase  from  the 
so-called  deliria,  under  which  term  Freud  places  mixed  conditions 
between  purely  rational  considerations  and  the  obsessive  thought 
processes  to  which  these  are  opposed ;  and  indeed  these  thoughts 
do  incorporate  some  of  the  presuppositions  of  the  obsession  which 
they  combat  and  by  the  aid  of  reason  take  their  place  in  the 
pathological  thought.  Into  these  deliria  also  enter  the  previously 
mentioned  misunderstandings;  still,  it  can  be  observed  that  the 
deliria  are  always  striving  to  gain  new  relations  to  the  content  and 
expression  of  the  obsession  which  are  not  appreciated  by  con- 
sciousness. In  the  recent  description  of  the  secondary  defence 
conflict,  Freud  also  points  out  the  genesis  of  the  so-called  pro- 
tective obsession  which  signifies  nothing  else  than  the  reaction, 
repentance  and  penitence,  to  an  opposite  impulse. 

The  obsessive  acts  often  show  an  alternating  course  in  which 
the  first  tempo  is  set  in  opposite  to  the  second.  We  do  not  exactly 
understand  this  second  part  of  the  obsessive  act  if  we  consider  it 
only  as  a  critical  aversion  to  the  pathological  act  which  he  would 


THE   OBSESSIONAL    NEUROSIS  IO9 

like  to  give  up.  The  obsessive  acts  represent  the  conflict  of  two 
impulses  of  opposite  but  equal  value,  chiefly  the  opposition  between 
love  and  hate,  which  plays  a  great  role  in  the  genesis  of  the 
obsessional  neurosis  and  also  finds  expression  in  its  symptoms. 
These  alternating  obsessive  acts  claim  an  especial  theoretical 
interest  because  they  disclose  a  new  type  of  symptom  formation. 
Instead  of  finding  a  compromise,  as  regularly  happens  in  hysteria, 
which  satisfies  both  opposing  forces  in  one  representation,  the  two 
opposing  forces  are  here  satisfied  individually,  first  one,  then  the 
other,  naturally  not  without  the  attempt  being  made  to  produce 
between  these  two  hostile  forces  a  kind  of  logical  union,  often  with 
the  destruction  of  all  logic. 

The  most  important  thing  in  the  new  work  of  Freud's  on  the 
obsessional  neurosis  is,  as  mentioned,  the  proof  of  the  funda- 
mental significance  of  original  instinct.  Characteristic  of  a  later 
obsessional  neurosis  is  the  appearance  of  a  special  aggression  and 
activity  in  childhood  which  expresses  itself  chiefly  in  an  intensive 
activity  of  the  impulse  to  peek  (Schautrieb)  and  to  know  (Wiss- 
trieb).  Instinct  has  been  especially  abundant  and  powerful  in 
childhood  and  succeeds  in  being  of  extraordinary  significance  in 
the  genesis  of  the  obsessional  neurosis  through  the  most  intensive 
elaboration  of  the  emotions  of  aflFection  and  hostility  toward  the 
parents,^^®  brothers  and  sisters  which,  in  conjunction  with  infantile 
sexual  curiosity  regarding  sex  and  birth  processes,  forms  the 
nuclear-complex  of  the  neurosis.  We  find,  however,  in  the  symp- 
tomatology of  the  obsessional  neurosis  a  continual  conflict  be- 
tween love  and  hate,  a  chronic  existence  side  by  side  of  these  two 
feelings  toward  the  same  person  and  indeed  both  emotions  in 
highest  intensity,  a  phenomenon  which  is  calculated  to  astonish 
us  when  we  always  find  it  in  these  patients.  Such  a  continuance 
of  contrasts  is  possible  only  under  peculiar  psychological  condi- 
tions and  through  the  cooperation  of  the  unconscious  condition. 
Love  has  not  extinguished  hate  but  only  succeeded  in  repressing 
it  into  the  unconscious,  where,  protected  from  elimination  through 
the  aid  of  consciousness,  it  can  exist  and  even  grow.  Under  these 
conditions,  conscious  love  attempts  by  way  of  reaction  to  expand 
to  an  especially  high  intensity  in  order  that  it  may  meet  the  con- 
stantly imposed  task  of  holding  its  opponent  in  repression.     A 

*™  Compare  the  already  mentioned  "  Odipuscomplex." 


no  FREUD  S  THEORY  OF   THE   NEUROSES 

very  early  separation  of  these  two  opposing  feelings  occurring  in 
the  earliest  years  of  childhood,  with  the  repression  of  one  of  them, 
commonly  hate,  seems  to  be  the  foundation  of  this  strange  constel- 
lation of  the  life  of  love.  Although  the  connection  between  the 
negative  factor  of  love  to  the  sadistic  component  of  the  sexual 
instinct  is  not  explained,  Freud  believes  that  he  can  give  out  the 
provisional  opinion  that  in  these  cases  of  unconscious  hate,  the 
sadistic  component  of  love  may  have  been  especially  strongly 
developed  constitutionally  and  have  received  a  premature  and  all 
too  profound  suppression;  thus,  the  phenomena  of  the  neurosis 
are  derived,  on  the  one  hand,  from  conscious  affection  highly 
developed  as  a  reaction,  on  the  other  hand,  from  the  sadism  con- 
tinually active  in  the  unconscious.^*"  This  sort  of  constitutional 
hate  component  is  accidentally  supported  by  the  traumata  received 
from  prohibitions  imposed  mostly  by  the  parents  (father)  which 
attain  a  great  significance  in  the  genesis  of  the  obsessional  neu- 
rosis. Thus,  a  vigorous  punishment  on  account  of  sexual  activity 
or  childhood  fault  in  connection  with  this,  becomes  a  strong  sup- 
porting measure  of  the  hate  which  originally  sprang  from  the 
parent-complex.  The  occasion  for  such  punishment  soon  arises 
for  a  definite  type  of  patient  who  is  later  afflicted  with  an  obses- 
sional neurosis,  shows  even  in  childhood  voluptuous  wishes  to 
which,  of  course,  uncomfortable  expectations  and  tendencies  to 
protective  acts  are  joined.  Thus,  a  conflict  is  present  in  the  men- 
tal life  of  these  little  voluptuaries;  beside  the  obsessional  wish 
stands  an  obsessional  fear  intimately  connected  with  the  wish. 
Thus,  a  sexual  instinct  and  a  rebellion  against  it,  a  wish  (not  yet 
obsessive)  and  fear  (already  obsessive)  striving  against  it,  a  pain- 
ful affect  and  the  compulsion  toward  protective  acts,  the  inventory 
of  the  neurosis  is  complete.  This  infantile  preliminary  stage  of 
the  neurosis  is  regularly  present  and  often  becomes  manifest  in 
the  child  as  disease.^** 

The  next  result  of  this  noteworthy  connection  between  love 
and  hate  which  is  demonstrable  in  every  case  of  obsessional  neu- 

**"  This  connection  also  explains  the  frequent  and  enigmatical  obses- 
sional laughing  on  occasions  of  sorrow  which  betrays  the  unconscious  joy 
at  the  suffering  or  downfall  of  the  unconsciously  hated  person. 

^"  Thus  beside  the  anxiety-hysteria,  the  obsessional  neurosis  is  a  second 
type  of  neurosis  of  childhood. 


THE  OBSESSIONAL   NEUROSIS  III 

rosis,  is  a  partial  weakening  of  the  will,  an  incapacity  for  resolu- 
tion in  all  actions  for  which  love  should  be  the  compelling  motive. 
The  irresolution,  however,  does  not  long  remain  limited  to  this 
group  of  acts,  but,  by  means  of  the  already  mentioned  mechanism 
of  displacement,  gradually  spreads  over  the  whole  range  of  the 
person's  activity.  Thereby  is  created  the  sway  of  obsession  and 
doubt  as  it  is  exhibited  in  the  mental  life  of  the  obsessional 
patients.  The  doubt  corresponds  to  the  inner  appreciation  of  the 
irresolution  which  as  a  result  of  the  inhibition  of  love  by  hate 
takes  possession  of  every  voluntary  act  of  the  patient  and  can 
spread  further  to  all  acts,  those  already  completed,  those  not  yet 
related  to  the  love-hate  complex  and  to  the  whole  past.  This  is 
really  the  doubt  of  the  power  to  love  which  should  be  subjec- 
tively the  greatest  certainty.  It  is  the  same  doubt  which,  in  pro- 
tective measures,  leads  to  uncertainty  and  continual  repetition 
which  finally  makes  these  protective  acts  become  as  impossible  of 
attainment  as  the  original  inhibited  love  resolution.  The  uncer- 
tainty of  the  patients  finds  expression  also,  for  example,  in  their 
prayers  imploring  the  sparing  of  the  life  of  another  which  uncon- 
scious phantasies  incessantly  interrupt;  these  phantasies  contain 
for  the  most  part  the  impulse  which  is  in  direct  contradiction  to 
the  petition  voiced  in  the  prayer. 

The  obsession  becomes  now  a  "  search  for  the  compensation  for 
the  doubt "  and  for  a  correction  of  the  unbearable  states  of  inhibi- 
tion to  which  the  doubt  refers.  If  the  patient,  by  the  aid  of  the 
displacement,  has  succeeded  in  bringing  any  one  of  the  inhibited 
intentions  to  a  decision,  this  demands  immediate  execution;  it  is 
indeed  no  longer  the  original  energy  belonging  to  the  intention  but 
the  pent-up  energy  which  now  finds  occasion  to  escape  by  the 
substitute  act.  It  thus  finds  expression  in  commands  and  prohi- 
bitions according  as  it  is  now  the  affectionate,  now  the  hostile 
impulse  which  gains  the  way  of  escape. 

By  a  kind  of  regression,  further  preparatory  acts  take  the 
place  of  the  final  resolution,  thought  replaces  action  and  some 
sort  of  mental  preparation  for  the  act  is  carried  out  by  obsessive 
force  instead  of  the  substitute  act  itself.  According  as  this  regres- 
sion from  motor  function  to  ideational  is  more  or  less  complete, 
the  case  of  obsessional  neurosis  assumes  the  character  of  obsessive 
thinking  (obsession)  or  obsessive  act  in  the  narrower  sense.    The 


112  FREUD  S  THEORY   OF   THE   NEUROSES 

point  in  question  is  in  what  stage  of  the  continual  progress  of  the 
defence  conflict  the  breaking  through  of  the  repressed  instinct 
takes  place  and  which  impulse  is  in  control.  This  acceptance  of 
a  thought  as  a  substitute  for  an  impulsive  act  makes  possible  the 
following  formula  for  the  psychological  characteristic  which 
gives  the  products  of  the  disease  its  obsessional  attribute:  those 
processes  tend  to  become  obsessions  which,  on  account  of  an 
opposing  inhibition  at  the  motor  end  of  the  nervous  system,  have 
taken  to  themselves  a  fund  of  energy  of  a  quality  and  quantity 
otherwise  used  only  for  motor  functions,  that  is  to  say,  thoughts 
which  necessarily  represent  regressive  acts. 

This  displacement  of  the  accent  from  the  motor  process  to  the 
thought  process  shows  the  obsessional  neurosis  to  be  in  general  a 
misuse  of  thinking.  The  pathological  exaggerations  of  the  obses- 
sonal  neurosis,  if  investigated  more  closely,  might  afford  great 
profit  for  the  understanding  of  the  intellectual  life  in  general. 
In  this  way,  Freud  was  able  to  derive  something  typical  from  the 
mental  peculiarities  of  his  case.  Thus,  the  peculiar  relation  to 
superstition,  death  and  reality,  which  is  different  in  those  suffer- 
ing from  obsessional  neurosis.  These  peculiarities  have  their 
ultimate  foundation  for  the  most  part  in  instinct.  Especially  does 
the  strange  conduct  toward  the  subject  of  death  and  the  intensive 
occupation  with  this  problem  attract  the  attention  of  the  physician. 
Those  obsessed  often  sympathize  warmly  in  all  cases  of  death  and 
piously  take  part  in  the  funerals.  This  strange  characteristic  of 
the  patients  rests  on  the  fact  that  as  children  they  came  into  con- 
tact with  the  problem  of  death  through  their  evil,  vengeful  wishes; 
as  compensation  for  this,  there  then  appears  their  intellectual  and 
emotional  occupation  with  this  subject,  thus  this  complex  is  also 
a  root  of  their  phantasies  of  the  future  life  (superstition).  Their 
superstitious  tendencies  have  for  the  most  part  absolutely  no  other 
content  and  in  general  have  perhaps  no  other  origin.  Before  all, 
however,  and  here  we  touch  on  one  of  the  motives  for  the  illness, 
they  need  the  possibility  of  death  as  a  solution  of  the  mental  con- 
flicts which  they  find  insoluble  by  themselves.  Their  essential 
characteristic  is  indeed  that  they  are  incapable  of  decision,  espe- 
cially in  matters  of  love.  Thus,  in  every  life  conflict,  they  look 
for  the  death  of  one  who  is  important  to  them,  usually  of  a  loved 
one,  it  may  be  a  parent,  a  rival  or  a  lover,  between  whom  their 
affection  wavers. 


THE  OBSESSIONAL   NEUROSIS  II 3 

Through  the  overvaluation  of  the  product  of  their  mental 
processes,  for  example,  the  possibility  of  causing  death  by  their 
thoughts  (wishes),  such  obsessed  patients  gradually  come  to 
believe  in  the  omnipotence  of  their  thoughts.  On  the  one  hand, 
there  is  also  in  this  belief  a  piece  of  the  old  childish  delusion  of 
grandeur.  Another  mental  need  which  has  a  certain  relationship 
to  the  one  already  mentioned  is  that  of  uncertainty  in  life  or  doubt. 
The  bringing  about  of  uncertainty  is  one  of  the  methods  which  the 
neurosis  adopts  to  draw  the  patient  away  from  reality,  to  isolate 
him  from  the  world,  which  is  indeed  the  tendency  of  every  psycho- 
neurotic disturbance.  The  predilection  of  the  patients  for  uncer- 
tainty and  doubt  becomes  a  motive  for  them  to  fasten  their 
thoughts  chiefly  on  those  subjects  where  uncertainty  is  common 
to  all  the  race  and  where  our  knowledge  or  our  judgment  must 
necessarily  remain  exposed  to  doubt.  Such  subjects  in  particular 
as  paternal  parentage,  duration  of  life,  life  after  death  and  the 
reliability  of  memory. 

An  especially  strange  trait  of  a  patient  with  obsessional  neurosis 
who  has  otherwise  a  fairly  high  degree  of  intelligence,  is  the  above 
mentioned  superstitiousness.  This  belongs  to  their  suflferings  but 
not  to  their  personality;  it  does  not  indeed  permeate  all  their 
thought.  The  patient  may  be  superstitious  during  the  illness  but 
otherwise  enlightened  and  a  freethinker.  In  this  connection,  they 
often  have  two  opposed  convictions,  not  one  incomplete  opinion. 
Between  these  two  convictions,  they  oscillate  in  the  most  obvious 
proportion  to  their  suffering.  This  superstition  is  thus  no  real 
conviction  with  the  patients  but  has  an  obsessive  character.  From 
the  analysis  of  cases  of  obsessional  neurosis,  a  deep  insight  into 
the  psychology  of  superstition  may  be  gained;  it  can  here  be 
recognized  that  superstition  springs  from  suppressed  hostile  and 
cruel  impulses.  Superstition  is  in  great  part  expectation  of  mis- 
fortune, and  he  who  has  frequently  wished  another  evil,  but  on 
account  of  being  trained  to  kindness  has  repressed  such  wishes 
into  the  unconscious,  will  find  it  especially  easy  to  anticipate  mis- 
fortune threatening  him  from  without  as  punishment  for  such 
unconscious  wickedness. 


CHAPTER  VIII 

PSYCHO-ANALYTIC   METHOD   OF  INVESTIGATION   AND 
TREATMENT 

Its  Peculiarity  (Specific  Therapy).  History  of  the  Development  of 
the  Method.  General  Technique.  Art  of  Interpretation.  Indications  and 
Contraindications.  The  Transference.  Refutation  of  the  Objections  to 
the  Method. 

Freud  has  expressed  himself  repeatedly  both  orally  and  in 
writing  concerning  his  psycho-analytic  technique,  which  has  com- 
pletely replaced  the  original  cathartic  and  hypnotic  methods; 
nevertheless,  there  is  still  lacking  a  detailed  and  systematic  rep- 
resentation especially  of  the  technical  rules  and  devices  founded 
on  painstaking  empiric  procedure.  In  spite  of  this,  a  number  of 
students  and  adherents,  who  in  great  part  are  in  close  touch  with 
Professor  Freud,  practice  the  therapy  according  to  his  directions 
and  their  own  auto-didactic  studies  and  experiments.  In  the 
hands  of  a  physician  not  sufficiently  versed  in  the  subject,  the 
therapy  can  easily  work  harm.  Psychotherapy  of  other  kinds  has 
nothing  in  common  with  psycho-analysis,  which  differs  from 
hypnosis  as  well  as  every  kind  of  suggestion  and  utilizes  the 
associations  as  well  as  the  dreams  of  the  patient  to  lay  bare  his 
unconscious.  Psycho-analysis  proceeds  from  the  "psychic  sur- 
face" and  seeks  from  there  in  narrative-like  penetration  to  set 
free  the  repressed  complexes  and  thereby  the  instinctive  impulses. 
The  superiority  of  this  over  the  methods  of  treatment  previously 
used  in  the  treatment  of  nervous  disorders  shows  best  in  the  fact 
that  while  acting  as  a  specific,  it  reveals  the  etiology  of  the  case. 
Thus  it  is  to  be  considered  as  theoretically  the  ideal  psychotherapy 
of  psychogenic  maladies.  Freud  does  not  mean  at  all  that  it  is 
always  and  in  all  cases  and  under  all  conditions  the  only  possible 
or  necessary  therapy  and  has  never  asserted  that  all  cases  of 
neurosis  are  therapeutically  accessible  or  that  all  can  be  cured. 
The  psycho-analytic  therapy  is,  however,  shown  by  experience  to 
work  the  most  impressively,  carry  the  farthest  and  accomplish 

114 


METHOD  OF  INVESTIGATION   AND  TREATMENT  II 5 

the  most  intense  changes  in  the  patients.  Quite  apart  from  the 
therapeutic  view-point,  we  are  indebted  to  this  irreplacable  method 
for  such  unexpected  enHghtenment  on  the  theory  of  the  neuroses 
as  more  than  compensates  for  the  only  occasional  bad  result  which 
no  therapy  escapes.  In  any  case,  psycho-analysis  is  the  most 
interesting  of  all  psychotherapies  because  it  alone  teaches  us 
something  of  the  origin  and  relations  of  the  disease  manifesta- 
tions. As  a  result  of  the  insight  into  the  mental  mechanism  of 
mental  diseases  which  it  opens  to  us,  it  alone  is  in  a  position  to 
lead  us  on  and  show  us  the  way  to  still  other  kinds  of  thera- 
peutic influences. 

The  particular  method  of  psychotherapy^*^  which  Freud  prac- 
tices and  calls  psycho-analysis  has  come  from  the  so-called 
cathartic  method  on  which  he  at  one  time  collaborated  with  J. 
Breuer  in  a  book  "  Studien  iiber  Hysteric."  The  cathartic 
therapy  was  a  discovery  of  Breuer's  by  the  aid  of  which  he  had, 
about  a  decade  previously,  restored  an  hysterical  patient  to  health, 
thereby  gaining  an  insight  into  the  pathogenesis  of  her  symptoms. 
At  the  personal  suggestion  of  Breuer,  Freud  then  took  up  the 
method  and  tested  it  on  a  large  number  of  patients. 

The  cathartic  method  presupposed  that  the  patient  is  hypno- 
tizable  and  rested  on  the  extension  of  consciousness  which  ap- 
peared in  hypnosis.  He  set  up  as  a  goal  the  removal  of  the  dis- 
ease symptom  and  attained  this  by  transferring  the  patient  back 
to  the  mental  state  in  which  the  symptom  first  appeared.  Then 
there  came  to  the  hypnotized  patient  memories,  thoughts  and 
impulses  which  had  previously  escaped  from  consciousness  and 
if  he  communicated  these  mental  processes  under  intense  expres- 
sions of  affect  to  the  physician,  the  symptom  was  overcome  and 
its  return  prevented.  This  apparently  regularly  recurring  experi- 
ence the  two  authors  explained  in  their  book  by  the  fact  that  the 
symptoms  stood  in  place  of  suppressed  psychic  processes  which 
could  not  appear  in  consciousness,  thus  represented  a  change 
("conversion")  of  the  latter.  The  therapeutic  efficacy  of  their 
method  they  explained  as  a  discharge  of  an  affect  dammed  up, 

"^The  following  review  of  "  Freudsche  psychoanalytische  Methode" 
is  in  some  points  an  enlarged  repetition  of  the  article  of  Freud's  by  the 
same  name.    Lit.  No.  i8. 


ii6  freud's  theory  of  the  neuroses 

as  it  were,  which  had  remained  from  the  suppressed  mental 
processes  (abreaction,  Abreagieren).  This  simple  scheme  of 
therapeutic  attack  was  complicated  nearly  all  the  time,  however, 
by  the  fact  that  not  a  single  "  traumatic  "  impression  but  usually 
a  complex  series  of  such  impressions  shared  in  the  origin  of  the 
symptom. 

The  chief  characteristic  of  the  cathartic  method,  which  puts  it 
in  contrast  to  all  other  methods  of  psychotherapy,  lies  in  the  fact 
that  in  this  procedure  the  therapeutic  efficiency  does  not  depend 
on  a  suggestive  command  of  the  physician.  It  anticipates  rather 
that  the  symptoms  will  disappear  if  the  attempt,  which  appeals 
to  certain  presuppositions  concerning  the  mental  mechanism, 
succeeds  in  bringing  the  mental  processes  into  different  channels 
than  they  have  previously  followed  in  the  formation  of  symptoms. 

The  modifications  of  the  cathartic  method  undertaken  were 
at  first  changes  in  the  technique;  these  brought  new  results  and 
have  necessitated  a  different  though  not  contradictory  conception 
of  the  therapeutic  work. 

As  the  cathartic  method  had  already  abandoned  suggestion,  so 
Freud  took  the  further  step  of  also  giving  up  hypnosis.  Since  the 
hypnotization,  in  spite  of  every  skill  of  the  physician,  interferes, 
as  is  known,  with  the  free  will  of  the  patient  and  a  great  number 
of  neurotic  persons  cannot  be  hypnotized  by  any  method,  thus 
through  the  abandonment  of  hypnosis,  the  applicability  of  the 
method  was  extended  to  an  unlimited  number  of  patients.  On  the 
other  hand,  the  extension  of  consciousness  was  omitted  which  had 
furnished  the  physician  just  that  psychic  material  in  memories 
and  ideas  by  the  help  of  which  the  transposition  of  the  symptoms 
and  the  freeing  of  the  affect  was  accomplished  If  no  substitute 
were  to  be  provided  for  this  deficiency  there  could  be  no  such 
thing  as  therapeutic  influence. 

Such  an  entirely  sufficient  substitute,  Freud  found  in  the 
associations  of  the  patient,  that  is,  in  the  involuntary  thoughts 
which  are  mostly  perceived  as  disturbing  ones  and  therefore  under 
ordinary  circumstances  disregarded;  these  involuntarily  press  to 
the  psychic  surface  in  the  "  recital  "of  the  patient  to  the  physician 
and  betray  the  disease  complex."'    Thus,  at  that  time  the  work 

*^**The  experimental  confirmation  of  this  presupposition  of  the  Freu- 
dian method  of  treatment  has,  as  already  mentioned,  been  afforded  by  the 


METHOD   OF   INVESTIGATION   AND   TREATMENT  II / 

proceeded  from  the  symptoms  and  set  up  the  solution  of  the  same 
serially  as  a  goal ;  Freud  has  since  given  up  this  method  because 
he  found  it  entirely  unsuited  to  the  finer  structure  of  the  neurosis. 
He  now  allows  the  patient  himself  to  determine  the  theme  of  the 
daily  work  and  by  this  means  proceeds  from  the  complex  which  is 
present  in  the  foreground  of  the  patient's  mind.  Thus,  one 
receives  all  kinds  of  material  which  belongs  to  a  solution  of  the 
symptom,  broken  into  fragments,  interwoven  in  different  connec- 
tions and  distributed  over  widely  separated  periods  of  time;  in 
spite  of  this  apparent  disadvantage  the  new  technique  far  sur- 
passes the  old. 

In  order  to  strengthen  these  associations,  Freud  uses  the  fol- 
lowing outside  means  of  assistance.  He  has  the  patient  recline 
comfortably  on  a  couch  while  he  sits  on  a  chair  behind  and  out  of 
his  line  of  vision.  He  does  not  insist  upon  the  eyes  being  closed 
and  avoids  any  touch  as  well  as  every  other  procedure  which 
might  lead  to  hypnosis.  Such  a  seance  goes  along  like  a  conver- 
sation between  two  similarly  awake  persons  of  whom  one  is 
relieved  of  every  muscular  tension  and  every  distracting  sense 
impression  which  might  disturb  the  concentration  of  the  attention 
upon  his  own  mental  affairs.  Before  he  proceeds  to  details,  he 
urges  them  often  for  several  sessions  to  sketch  a  general  picture 
of  their  whole  illness  and  most  intimate  family  and  life  surround- 
ings,^** to  tell  him  everything  which  comes  into  their  heads 
whether  they  think  it  important,  irrelevant  or  nonsensical.  With 
special  emphasis,  it  is  asked  of  them  that  no  thought  or  association 
be  omitted  from  the  communication  because  this  telling  might  be 
shameful  or  painful.  In  taking  pains  to  collect"^  this  material 
from  associations  which  would  otherwise  have  been  pushed  aside, 
Freud  now  made  the  observations  which  have  become  determin- 

association  experiments  undertaken  by  the  Zurich  school  which  many 
psycho-analysts  use  to  gain  associations  from  patients. 

***  It  is  not  recommended  that  the  psycho-analyst  undertake  an  investi- 
gation of  the  somatic  conditions  himself  but  where  possible  to  have  this 
done  by  a  specialist  in  that  line. 

^**  Freud  warns  expressly  against  taking  up  the  time  of  the  treatment 
itself  with  making  notes  of  the  conversation  of  the  patient  because  this 
would  awaken  a  mistrust  on  the  patient's  part  and  confuse  the  physician 
in  the  appreciation  of  the  material  produced.  Notes  made  afterwards  are 
nevertheless  indispensable. 


ii8  freud's  theory  of  the  neuroses 

ing  for  his  whole  conception.  Already  in  this  narration  of  the 
patient's  history,  there  appear  defects  of  memory;  perhaps  actual 
occurrences  are  forgotten  or  temporal  relations  twisted  or  causal 
relations  distorted  so  that  incomprehensible  effects  result.  No 
neurotic  clinical  history  is  free  from  amnesia  of  some  kind.  The 
psycho-analyst  can  only  wonder  how  the  smooth  and  exact  clin- 
ical histories  of  hysterical  cases  are  produced  by  other  authors. 
Only  in  the  course  of  the  treatment  does  the  patient  bring  forth 
what  he  has  held  back  or  what  has  not  occurred  to  him,  although 
he  has  always  known  it.  When  one  urges  the  narrator  to  fill  in 
these  breaks  in  his  memory  by  concentrated  attention,  one  dis- 
covers that  the  interrupted  associations  are  held  back  from  him 
by  all  the  means  of  critique  until  the  patient  finally  feels  direct 
discomfort  if  the  memory  has  really  stopped.  From  this  experi- 
ence, Freud  concluded  that  the  amnesias  are  the  result  of  the 
process  which  he  has  described  as  repression  (Verdrangung). 
The  psychic  forces  which  have  caused  this  repression  are  to  be 
detected  in  the  resistance  which  sets  itself  against  the  revival  of 
the  memories.  To  seek  out  and  overcome  these  resistances  is  the 
most  important  part  of  the  therapeutic  work. 

The  agency  of  the  resistance  has  become  one  of  the  funda- 
mentals of  the  Freudian  theory.  He  considers  the  associations 
side-tracked  under  all  sorts  of  pretexts,  as  descendants  of  the 
repressed  psychic  structures  (thoughts  and  emotions),  as  dis- 
tortions of  the  same  by  the  opposition  of  the  resistance  against 
their  reproduction.  Further,  the  associations  of  the  patient  are 
quasi-symptoms,  new,  artificial  and  ephemeral  substitutions  for 
the  repressed  material  but  already  so  much  distorted  that  they 
have  only  the  remotest  resemblance  to  the  repressed  material.  If 
the  resistance  is  not  too  intense,  it  may  be  possible  to  guess  from 
the  association  the  desired  concealed  material.  The  greater  the 
resistance,  the  more  pronounced  the  distortion.  In  this  relation 
of  the  undirected  associations  to  the  repressed  psychic  material, 
rests  its  value  for  the  therapeutic  technique.  If  one  possesses  a 
method  which  renders  it  possible  to  discover  the  repressed  mate- 
rial from  the  associations,  the  things  distorted  from  the  original, 
then  one  can,  without  hypnosis,  make  attainable  to  consciousness 
the  earlier  unconscious  material  in  the  mental  life. 

In  this  regard,  Freud  has  elaborated  an  interpretation  tech- 


METHOD  OF  INVESTIGATION  AND  TREATMENT  II 9 

nique.  that  accomplishes  this  task;  this  might  be  described  as 
recovering  from  the  ore  of  unguided  associations  the  metal  con- 
tent of  repressed  thoughts.  The  objects  of  this  interpretation 
technique  are  not  merely  the  associations  of  the  patient  but  also 
his  dreams  which  afford^*®  the  most  direct  entrance  to  the  uncon- 
scious, his  unintentional  acts  such  as  aimless  acts  (symptomatic 
acts)  and  the  mistakes^"  of  his  performances  in  everyday  life 
(misstatements,  misunderstandings,  etc.).  According  to  Freud, 
there  is  a  series  of  empiric  rules  which  enable  the  analyst  to  con- 
struct the  unconscious  material  from  the  associations  of  the 
patient;  instructions  concerning  what  one  is  to  understand  if  the 
associations  of  the  patient  contradict  and  examples  of  the  most 
important  typical  resistances  which  appear  in  the  course  of  such 
a  treatment. 

Although  as  yet  Freud  has  published  no  collected  representa- 
tion"* of  the  details  of  this  interpretation  and  translation  tech- 
nique, still  there  are  in  his  "  Bruchstiick  einer  Hysterieanalyse  "^*^ 
some  preliminary  references  to  the  overcoming  of  certain  difficul- 
ties which  appear  regularly  in  every  psycho-analytic  treatment; 
these  may  be  removed  only  by  an  exact  knowledge  of  their 
psychic  motives  and  the  communication  of  this  to  the  patient. 

If  it  would  seem  at  first  that  one  might  rely  on  the  flow  of 
associations,  on  the  interpretation  of  which  the  treatment  depends, 
even  a  short  investigation  teaches  every  time  that,  as  it  lies  in  the 
nature  of  the  whole  method  of  treatment  and  its  presuppositions, 
the  analysis  is  often  interrupted  by  the  resistances  combating  the 
laying  bare  of  the  repressions.    The  removal,  that  is,  the  exposing 

***  Freud  shows  the  value  of  the  technique  of  dream  interpretation  in 
the  psycho-analytic  treatment  in  a  book  entitled  "  Bruchstiick  einer  Hys- 
terieanalyse"  (Lit.  No.  31).  One  must  not  expect  that  every  dream  right 
at  the  beginning  of  the  treatment  may  be  completely  interpreted  before 
one  is  oriented  in  relation  to  the  most  important  complexes  of  the  patient. 

^*'  The  interpretation  technique  of  mistakes  is  in  "  Psychopathologie 
des  AUtagslebens,"  Lit.  No.  16, 

"*The  comprehensive  work  on  dream  interpretation  ("Traumdeu- 
tung")  is  to  be  considered  a  precursor  to  such  an  introduction  to  the 
technique. 

*"  Those  of  the  following  rules  which  are  not  derived  from  this 
analysis  are  taken  from  Freud's  lectures  on  "  Methodik  der  Psycho- 
therapie"  delivered  in  the  winter  semester  1908,  the  publication  of  which 
is  in  preparation. 


I20  freud's  theory  of  the  neuroses 

of  these  resistances,  is  the  chief  task  of  the  technique ;  after  this 
has  been  accomplished,  the  material  necessary  for  the  uncovering 
of  the  complexes  reveals  itself.  The  physician  must  be  prepared 
for  these  resistances  which  clothe  themselves  in  the  most  varied 
forms  and  lead  to  pauses  in  the  associations  of  the  patient.  The 
pauses  have,  as  experience  gained  from  numerous  analyses  shows, 
certain  typical  and,  for  the  skillful  physician,  readily  transparent 
causes.  Thus,  a  gross  sexual  memory,  the  communication  of 
which  to  the  physician  may  be  withheld  contrary  to  the  conditions 
of  the  treatment,  keeps  constantly  recurring  to  the  patient  against 
his  will  and  regularly  leads  to  such  a  break  in  the  associations. 
Similarly,  works  a  disturbance  of  the  relation  to  the  physician :  it 
may  be  the  feeling  of  an  especially  intense  antipathy  or  sympathy 
which  will  not  be  betrayed  by  the  patient.  Further,  the  material 
side  of  the  treatment,  an  impatience  over  a  relatively  long  dura- 
tion of  the  treatment  can  interrupt  the  flow  of  associations.  The 
resistance  also  frequently  expresses  itself  in  the  fact  that  the 
otherwise  copious  dream  reports  stop  or  flow  in  such  fulness  and 
extent  that  the  placing  of  them  in  the  framework  of  the  treatment 
becomes  impossible.  The  skillful  psycho-analyst  will  explain  to 
the  patient  how  the  resistance  stands  in  the  way  and  the  motive 
for  his  denial  of  associations  from  case  to  case  whereby  the  anal- 
ysis can  almost  always  proceed  more  rapidly  since  every  time, 
through  the  elimination  of  the  resistance,  the  entrance  to  new 
unconscious  material  becomes  free  which  this  resistance  really 
only  serves  to  conceal. 

As  already  described,  besides  the  associations  and  dreams  of 
the  patient,  the  so-called  symptomatic  acts  have  great  importance 
for  the  explanation  of  the  unconscious  mental  life.  Under  this 
term  Freud  understands  those  actions  which  a  person  carries  out 
as  they  say  "  automatically,  unconsciously,  without  thinking  about 
them,  as  if  playing,"  to  which  they  would  deny  any  significance 
and  if  questioned  about  them  explain  as  indifferent  and  accidental. 
Careful  observation  shows  that  such  acts,  of  which  consciousness 
knows  nothing  or  wishes  to  know  nothing,  give  expression  to 
unconscious  thoughts  and  impulses  which  are  valuable  and  illumi- 
nating as  unpermitted  expressions  of  the  unconscious.  Besides 
the  unlimited  number  of  possibilities  for  individual  and  specific 


METHOD  OF  INVESTIGATION   AND  TREATMENT  121 

symptomatic  acts^^°  certain  typical  forms  regularly  take  a  hand  m 
the  psycho-analysis.  Thus,  the  patient's  tardiness  in  coming  to 
the  treatment  often  indicates  a  secret  resistance  against  his  com- 
ing on  this  day;  still  more  clearly  does  the  remaining  entirely 
away  from  the  appointment  speak  for  an  ordinarily  very  weakly 
motivated  ground  for  the  prevailing  powerful  resistance.  Just  as 
important  as  symptomatic  acts  are  all  those  first  communications 
of  the  patient  especially  at  the  beginning  of  the  treatment  and 
also  the  first  expressions  sometimes  made  at  the  beginning  of  each 
consultation  hour.  In  similar  indirect  manner  as  the  patient  com- 
municates to  the  physician  by  means  of  symptomatic  acts,  the 
direct  expression  of  which  is  not  possible  or  painful  to  him,  so 
also  the  next  dream  may  bring  to  expression  the  same  material  in 
veiled  terms. 

Besides  these  aphoristic  communications  of  a  general  nature, 
Freud  has  given  in  their  practical  application,  in  his  published 
pamphlet  on  an  analysis  of  a  case  of  hysteria,  some  of  the  rules 
of  interpretation  gained  empirically.  Especially  in  some  illumi- 
nating references  to  reactions  of  the  patient  to  certain  instruc- 
tions or  communications  of  the  physician  which  reveal  uncon- 
scious processes.  Among  these  reactions  of  the  patient,  the  one 
called  by  Freud  the  "  unconscious  yes  "  is  especially  to  be  noticed ; 
under  this  term,  Freud  understands  associations  which  contain 
something  corresponding  to  the  assertion  of  the  physician  but  not 
directly  confirmatory.  A  further  indirect  confirmation  that  the 
veiled  unconscious  material  has  become  manifest  to  conscious 
perception  is  an  accidental  laughing  by  the  patient  in  the  treat- 
ment which  occurs  when  the  content  of  disclosed  material  in  no 
way  justifies  it.  Other  forms  of  affirmation  are  a  failure  to  under- 
stand things  which  come  from  the  unconscious ;  in  general,  there 
is  no  "  unconscious  no."  From  this  standpoint,  "  no  "  which  one 
is  accustomed  to  hear  from  the  patient  after  one  has  first  laid  bare 
the  unconscious  thoughts  to  his  conscious  perception,  is  to  be 
received  only  as  a  continuation  of  the  repression ;  its  resoluteness 
likewise  lacks  the  strength  of  the  same.  If  one  considers  this 
"no"  not  as  the  expression  of  an  impartial  judgment,  of  which 
the  patient  is  not  capable,  but  passes  lightly  over  it  and  continues 

^^  Examples  of  these  may  be  found  in  "  Bruchstuck  einer  Hysteric- 
analyse  "  as  well  as  in  the  "  Psychopathologie  des  AUtagslebens." 


122  FREUD  S   THEORY   OF   THE    NEUROSES 

the  work,  the  first  evidence  soon  appears  that  "  no "  in  such  a 
case  has  the  significance  of  the  expected  yes.  In  a  similar  sense 
is  also  to  be  considered  the  very  frequent  manner  of  the  patient 
in  seeking  to  reject  some  information  which  has  come  up  out  of 
the  repressed  by  replying  to  a  hint  of  the  physician  concerning 
this  with  "  I  knew  you  would  say  that ! "  A  further  rule  which 
has  been  derived  empirically  from  psycho-analytic  technique  is 
that  an  inner  but  still  hidden  connection  is  indicated  by  the  con- 
tiguity, the  temporal  relationship  of  the  associations,  just  as  a  and 
b  in  script  placed  beside  each  other  mean  that  the  syllable  ab 
should  be  formed.  A  further  experience  teaches  that  in  cases 
where  the  narrator  is  doubtful  in  expressing  an  opinion,  one 
should  entirely  overlook  this  uncertainty  and  consider  the  opinion 
in  the  affirmative  sense.  Between  the  two  forms  of  a  wavering 
presentation  one  should  consider  the  first  given  as  the  correct  one, 
the  second  as  a  product  of  the  repression.  Based  on  this  experi- 
ence is  the  device  of  the  interpreter  of  dreams  of  having  a  dream 
related  a  second  time  and  beginning  the  work  of  interpretation 
at  the  places  which  have  been  changed  as  the  least  assured. 

From  this  highly  incomplete  and  unsystematized  information 
concerning  the  technique  of  the  psycho-analytic  method,  one 
might  conclude  that  the  originator  of  the  system  had  caused  him- 
self an  excessive  aijiount  of  trouble  and  done  wrong  in  giving  up 
the  less  complicated  hypnotic  methods.  But  on  the  one  hand, 
the  technique  of  psycho-analysis  is  much  easier  to  practice,  once 
it  has  been  learned,  than  a  description  of  it  would  indicate;  on 
the  other  hand,  no  other  way  leads  to  the  goal,  hence  the  round- 
about way  is  the  shortest.  Hypnosis  is  to  be  rejected  because  it 
covers  the  resistance  and  thereby  obstructs  the  physician's  view 
of  the  play  of  mental  forces.  It  does  not  remove  the  resistance, 
but  only  evades  it,  gives  incomplete  information  and  only  tem- 
porary results. 

The  task  which  the  psycho-analytic  method  is  called  upon  to 
solve  may  be  expressed  in  different  formulae  which  are,  however, 
essentially  equivalent.  It  may  be  said,  the  object  of  the  treat- 
ment is  to  abolish  the  amnesias.  If  all  the  gaps  in  the  memory 
are  filled  out,  all  enigmatical  effects  of  the  mental  life  explained, 
a  continuance,  indeed  a  recurrence  of  the  suffering  is  rendered 
impossible.    The  condition  may  be  put  differently :  to  trace  back 


METHOD   OF   INVESTIGATION   AND   TREATMENT  123 

all  repressions;  the  mental  condition  is  then  the  same  as  that  in 
which  all  amnesias  are  filled.  Far  more  important  is  another  con- 
ception: to  make  the  unconscious  attainable  to  consciousness, 
which  comes  about  through  the  overcoming  of  the  resistances. 
Thereby  a  piece  of  educational  work  is  accomplished  and  for 
such  a  reeducation  for  the  overcoming  of  the  deviations  of  child- 
hood, one  can  conceive  a  very  general  application  for  the  psycho- 
analytic treatment.  One  must  not  forget,  however,  that  such  an 
ideal  condition  does  not  exist  among  normal  people  and  that  only 
seldom  does  one  have  the  opportunity  to  conduct  the  treatment 
so  far.  Just  as  health  and  sickness  are  not  separate  entities  but 
are  only  divided  by  practical  definite  boundaries,  so  one  will  never 
set  up  as  a  goal  for  the  treatment  anything  but  the  practical  heal- 
ing of  the  sick,  the  restoration  of  their  power  to  work  and  love. 
In  an  incomplete  treatment  or  incomplete  results  of  the  same,  one 
gains  especially  an  important  improvement  of  the  general  mental 
condition  while  one  or  another  symptom,  but  with  diminished  sig- 
nificance for  the  patient,  can  continue  without  branding  him  as 
an  invalid. 

Aside  from  certain  modifications  which  the  representation  of 
a  special  therapy  demands,  the  therapeutic  method  remains  the 
same  for  all  the  clinical  pictures  of  the  many  varieties  of  hysteria 
as  well  as  for  all  manifestations  of  the  obsessional  neurosis.  Of 
the  unlimited  applicability  of  the  same,  there  is  no  question.  The 
nature  of  the  psycho-analytic  method  imposes  indications  and 
contraindications  both  in  regard  to  the  persons  to  be  treated  and 
also  to  the  clinical  picture.  Most  favorable  for  psycho-analysis 
are  the  chronic  cases  of  psychoneuroses  with  few  violent  or  dan- 
gerous symptoms;  thus,  all  kinds  of  obsessional  neurosis,  obses- 
sional thinking  or  obsessional  acts  and  cases  of  hysteria  in  which 
phobias  and  abulias  play  the  chief  roles ;  further  also  all  somatic 
expressions  of  hysteria  except  those,  such  as  anorexia,  where  a 
rapid  amelioration  of  the  symptoms  is  the  chief  task  of  the  physi- 
cian. In  acute  cases  of  hysteria,  one  must  await  the  appearance 
of  a  quiet  state;  in  all  cases  in  which  nervous  exhaustion  is  the 
prominent  symptom,  one  should  avoid  a  method  which  itself 
demands  an  effort,  makes  only  slow  progress  and  for  a  long  time 
can  pay  no  regard  to  a  continuation  of  the  symptoms. 

Concerning   the   persons   on   whom   psycho-analysis  can   be 


124  FREUD  S   THEORY   OF   THE   NEUROSES 

undertaken  with  profit,  there  are  several  conditions  to  be  observed. 
First  of  all,  they  must  possess  a  normal  mental  condition  from 
which  the  pathological  material  can  be  gained ;  in  times  of  mental 
confusion  or  melancholic  depression,  though  of  hysterical  type, 
nothing  can  be  accomplished.  Further,  a  certain  degree  of  natural 
intelligence  and  ethical  development  is  necessary;  with  worthless 
persons,  the  interest  of  the  physician  which  strengthens  him  for 
delving  into  the  mental  life  of  the  patient  soon  wanes.  Outspoken 
defects  of  character,  traits  of  actual  constitutional  degeneration 
exhibit  themselves  in  the  treatment  as  sources  of  resistances  which 
can  scarcely  be  overcome.  In  general,  the  constitution  sets  a  limit 
for  the  effectiveness  of  psychotherapy.  A  too  mature  age,  in  the 
neighborhood  of  the  fifth  decade,  imposes  unfavorable  condi- 
tions for  psycho-analysis.  The  mass  of  psychic  material  is  then 
no  longer  amenable  to  change,  the  time  required  for  a  cure  becomes 
too  long  and  the  possibility  of  making  psychic  processes  attain- 
able begins  to  diminish. 

In  spite  of  all  these  limitations,  the  number  of  persons  suited 
to  psycho-analysis  is  extraordinarily  large  and  the  increase  of  our 
therapeutic  power  by  this  method  is  very  considerable.  Freud 
demands  a  long  period  of  time,  from  a  half  to  three  years,  for 
an  effective  treatment ;  he  says,  however,  that  so  far  he  has  applied 
his  treatment,  because  of  circumstances  easily  guessed,  to  very 
severe  cases,  persons  with  maladies  of  many  years  duration  and 
complete  incapacity  for  work,  who  having  tried  all  treatments 
came  to  his  new  and  much  disputed  treatment  as  a  last  resort. 
In  cases  of  less  severity,  the  duration  of  the  treatment  might  be 
correspondingly  shortened  and  an  extraordinary  gain  be  made  for 
prevention  in  the  future.  This  applies  especially  to  the  neuroses 
of  children,  the  frequency  and  importance  of  which  is  not  yet 
sufficiently  appreciated;  according  to  the  results  obtained  so  far, 
they  are  very  favorable  cases  for  psycho-analysis.  For  the  treat- 
ment of  these,  it  is  recommended  that  besides  the  personal  obser- 
vation of  the  child,  his  involuntary  expressions  be  observed  by  a 
trustworthy  and  suitable  person  (preferably  when  possible,  the 
parents)  who  can  keep  him  under  observation  the  whole  time. 
As  a  means  of  combating  the  insanities,  the  method  is  not  yet 
correspondingly  elaborated  and  modified;  still,  isolated  cases  of 
investigation  undertaken  by  the  Zurich  school  seem  to  justify  the 


METHOD  OF  INVESTIGATION   AND  TREATMENT  12$ 

expectation  that  the  psycho-analytic  method  may  prove  thera- 
peutically effective  up  to  a  certain  point  in  some  forms  of  insanity, 
such  as  dementia  praecox  and  paranoia. 

The  art  of  psycho-analytic  treatment  as  described,  which 
places  the  greater  share  of  work  on  the  patient,  might  awaken 
the  idea  that  we  are  dealing  with  a  technique  easily  learned  and 
applied.  If  it  be  granted  that  its  practice  by  a  skilled  physician 
suited  to  it,  with  sufficient  time  to  give  to  it,  offers  no  difficulties, 
still,  the  acquirement  of  the  technique  demands  great  perseverance 
and  patience  especially  from  beginners.  First  of  all,  the  patient's 
associations,  which  are  the  foundation  of  the  treatment,  do  not 
always  flow  as  freely,  fully  and  in  the  desired  clearness  as  is  nec- 
essary for  a  perceptible  progress  of  the  treatment.  The  very 
nature  of  the  neurotic  malady  and  the  processes  of  repression  at 
work  causing  it  makes  certain  that  the  different  psychic  inhibi- 
tions can  be  removed  only  under  a  resistance,  the  size  of  which 
corresponds  to  the  forces  which  had  shared  in  the  repression. 
The  patient,  because  of  the  malady,  applies  all  the  means  of  the 
censor,  concealment,  disguise,  symbolism,  to  render  inaccessible 
the  object  of  the  search,  the  repressed  unconscious  sexual  root. 
Thus,  the  treatment  progresses  under  a  constant  struggle  against 
the  ever-appearing  resistance.  The  disclosure  of  the  uncon- 
scious mental  life  is  of  necessity  accompanied  by  discomfort  and 
hence  always  retarded  by  the  patient.  One  can  estimate  the 
difficulties  of  the  process  by  considering  that  the  treatment  only 
approaches  its  end  when  all  the  strata  of  the  mental  life  have 
been  penetrated  and  all  gaps  in  memory  (amnesias)  of  the  patient, 
even  to  the  earliest  childhood,  have  been  filled  out.  The  great 
abundance  of  experiences  which  after  decades  of  sickness  finally 
become  inexhaustible  as  well  as  the  necessary  resistances  under 
which  the  actual  rendering  conscious  of  the  unconscious  proceeds 
are  the  circumstances  which  sorely  try  the  patience  of  patient  and 
physician  and  can  protract  the  treatment  many  months  and  even 
years.  This  demand  on  the  patience  of  the  patient  diminishes  in 
contrast  to  the  patience  which  the  continuance  of  the  pathological 
phenomena  requires  of  him. 

In  the  end,  it  is  the  content  of  infantile  repression  which  con- 
tains the  pathogenic  material   which  cannot  be  at   all  clearly 


126  freud's  theory  of  the  neuroses 

obtained  from  the  patient  but  must  be  in  part  guessed  by  the 
physician  on  the  ground  of  his  previous  experience  and  arranged 
so  that  the  patient's  consciousness  will  perceive  his  unconscious 
wish-impulses.  We  attain  this  by  bringing  before  his  conscious- 
ness in  our  own  language  the  unconscious  complexes  which  he  has 
given  hints  of  possessing  and  which  the  art  of  interpretation  has 
assisted  in  revealing.  The  similarity  between  what  he  has  heard 
and  what  he  seeks  will  penetrate  consciousness  in  spite  of  all  resist- 
ance and  put  him  in  a  position  to  find  the  unconscious.  The 
physician  is  a  little  ahead  in  comprehension,  the  patient  follows 
in  his  own  way  until  both  reach  the  goal  aimed  at.  Beginners  in 
psycho-analysis  seek  to  change  these  two  points  and  to  consider 
the  time,  at  which  they  recognized  an  unconscious  complex  of  the 
patient,  the  same  as  that  at  which  the  patient  perceived  it.  They 
expect  too  much  if  they  would  heal  the  patient  by  communicating 
this  knowledge,  for  he  can  only  use  the  communication  as  an  aid 
in  finding  the  unconscious  complex  in  his  unconscious  where  it  is 
fixed.  With  this  part  of  the  analysis,  that  purely  expectant  atti- 
tude of  the  physician  which  was  formerly  laid  down  as  a  condition 
of  the  treatment  finds  a  limitation.  It  is  important  here  that  the 
skillful  physician  should  not  leave  his  patient  imprepared  and  as 
a  rule  he  has  to  ask  from  him  not  enlightenment  but  merely  con- 
firmation of  his  suspicions.  The  psycho-analysis  of  a  patient  is 
no  aimless  scientific  investigation  but  a  therapeutic  procedure;  it 
wishes  to  prove  nothing,  merely  to  change  something.  Every  time 
in  the  analysis,  the  physician  gives  the  patient  the  conscious  ideas 
expected,  by  the  help  of  which  he  will  be  in  position  to  recognize 
and  comprehend  the  unconscious.  What  the  physician  communi- 
cates to  the  patient  comes  from  other  anal)rtic  experiences  and  it 
is  really  proof  enough  if  by  the  aid  of  this  medical  intervention 
the  connection  and  solution  of  the  pathogenic  material  is  attained. 
The  best  way  to  introduce  these  expected  ideas  is  by  giving  the 
patient  on  suitable  occasion  a  view  of  the  meaning  and  procedure 
of  psycho-analytic  therapy  as  well  as  its  psychological  presupposi- 
tions, for  example,  by  explaining  to  him  the  importance  of  the 
psychological  distinction  between  conscious  and  unconscious,  con- 
cerning infantilism,  etc.,  and  wherever  possible  allowing  him  to 
find  and  comprehend  it  from  his  own  material.^''^    Nevertheless, 

*"  The  reading  of  published  articles  by  the  patient  is  not  advantageous 
to  the  treatment. 


METHOD  OF  INVESTIGATION  AND  TREATMENT  12/ 

it  should  never  be  the  aim  of  such  discussions  to  convince.  They 
should  introduce  the  repressed  complexes  to  consciousness,  insti- 
gate the  strife  with  them  on  the  floor  of  conscious  mental  activity 
and  render  easier  the  appearance  of  new  material  from  the  uncon- 
scious. Conviction  comes  only  after  the  material  won  from  the 
unconscious  has  been  elaborated  by  the  patient,  and  so  long  as  he 
is  wavering  one  must  consider  the  material  as  not  exhausted. 

Without  having  won  an  intellectual  conviction,  however,  the 
patients  indulge  in  that  peculiar  cessation  of  authoritative  belief 
and  of  the  need  of  instruction  from  the  physician  and  on  the  con- 
trary show  an  emotional  interest  in  these  things  and  through  this 
to  gradually  participate  intellectually  in  the  theory.  We  come 
here  upon  a  highly  important  agency  of  the  psycho-analytic  treat- 
ment, namely,  the  condition  of  "transference"  ("Ubertra- 
gung")^^^  as  Freud  has  called  that  peculiar  psychic  dependence  and 
respectful  sympathy  which  the  neurotic  brings  to  the  physician 
whom  he  trusts,  and  without  the  appearance  of  which,  as  occa- 
sionally happens  because  of  uncongenial  personalities,  the  treat- 
ment terminates  spontaneously  soon  after  its  beginning.^^^  This 
so-called  transference  is  at  bottom  nothing  else  than  what  occurs 
in  every  psychic  influencing,  indeed  one  can  say  that  in  general  no 
medical  treatment  is  possible  without  a  certain  degree  of  confiding 
sympathy  from  the  sufferer.  According  to  Freud's  experience, 
it  is  especially  certain  that,  for  example,  the  sanitarium  treatment 
also  depends  only  on  such  a  subordination  of  sympathetic  emo- 
tions to  the  authority  of  the  esteemed  physician.  Now,  neurotics 
are  really  much  richer  in  free  movable  craving  for  love  (libido), 
the  quantity  of  which  is  constantly  increased  by  the  analytic 
breaking  down  .of  inhibitions,  so  that  it  is  no  wonder  that  this 
sympathetic  relation  to  the  physician  becomes  more  intense  and 
emotionally  toned  than  in  patients  with  organic  disease.  What  is 
more  obvious  than  that  this  free  floating  libido  (in  widest  extent 
of  eroticism)  freed  from  the  repression  in  the  way  of  sublimated 

"'A  comprehensive  presentation  of  the  "transference"  is  deferred 
until  the  title  "general  therapy"  is  reached.  As  preliminary,  compare 
Freud  (Lit.  No.  21)  as  well  as  Ferenczi,  "Introjektion  und  Ubertragung  " 
(Jahrb.,  I,  page  422). 

"*  Striking  results  right  at  the  beginning  of  the  psycho-analytic  treat- 
ment rest  merely  on  transference  and  are  mostly  only  temporary  apparent 
results. 


128  freud's  theory  of  the  neuroses 

homo-  or  heterosexuality  should  be  transferred  to  the  attending 
physician  whose  intimate  and  prolonged  deahng  with  the  mental 
life  of  patients  is  the  most  favorable  soil  for  such  seeds.  Thus, 
transference  is  not  a  specific  result  of  psycho-analytic  therapy  but 
it  appears  here  most  clearly  because  of  the  conditions  under  which 
the  treatment  is  carried  out.  Sentimental  critics  need  not,  how- 
ever, get  angry  at  the  thought  that  the  physician  could  use  or 
abuse  this  relation  in  any  way.  On  the  contrary,  the  real  effect- 
iveness of  this  most  important  aid  in  the  psycho-analytic  treat- 
ment consists  just  in  the  fact  that  one  has  to  continually  release 
the  patient  from  his  transference  by  explaining  to  him  that  his 
whole  intense  interest  in  the  person  of  the  physician  is  only  a 
transference  of  previous  emotional  impulses  originally  directed 
toward  other  persons.  The  productivity  of  the  neurosis  is  really 
not  interrupted  during  the  psycho-analytic  treatment,  although 
the  new  formation  of  symptoms  ceases,  but  busies  itself  in  the 
creation  of  a  special  kind  of  thought  formations,  mostly  uncon- 
scious, to  which  the  name  transference  is  given  for  the  reason 
that  they  are  new  editions,  later  expressions  of  impulses  or  phan- 
tasies which  have  been  awakened  during  the  progress  of  the  anal- 
ysis and  should  be  made  conscious.  These  transference-phantasies 
show  themselves  by  a  characteristic  replacement  of  an  earlier 
person  by  the  person  of  the  physician.  To  put  it  differently :  A 
whole  series  of  earlier  psychic  events  becomes  active  again,  not 
as  something  which  has  happened,  but  as  an  actual  relation  to  the 
physician.  To  use  Ferenczi's  apt  comparison  from  chemistry,  the 
physician  plays  the  role  of  a  catalytic  ferment,  which  in  the 
process  of  setting  free  affects,  draws  them  to  itself.  There  are 
transferences  which  in  their  contents  are  to  be  distinguished  from 
their  prototype  in  absolutely  nothing.  Thus,  they  are  special 
reprints,  unchanged  new  editions.  Others  are  artfully  created 
and  have  undergone  a  toning  down  of  their  content,  a  sublima- 
tion, and  thus  resemble  new  works.  The  transference  is  a  neces- 
sary part  of  every  psycho-analytic  treatment  and  one  can  easily 
convince  himself  in  practice  that  it  is  in  no  way  to  be  avoided  and 
that  this  last  phenomenon  of  the  malady  has  to  be  combated  like 
all  the  earlier  ones.  This  part  of  the  work  is  by  far  the  hardest 
because  one  must  guess  the  transference,  independently,  without 
any  help  from  the  patient,  in  insignificant  stopping  points  and 


METHOD  OF  INVESTIGATION  AND  TREATMENT  I  29 

without  making  himself  guilty  of  arbitrariness.  To  avoid  it,  how- 
ever, is  impossible,  since  it  is  applied  for  the  origination  of  all  the 
obstructions  which  render  the  material  inaccessible. 

One  will  be  inclined  to  consider  it  a  great  disadvantage  of  a 
method  otherwise  inconvenient  that  it  still  increases  the  work  of 
the  physician  through  the  creation  of  a  new  kind  of  pathological 
psychic  product,  indeed  perhaps  may  work  injury  to  the  patient 
by  the  analytic  treatment  through  the  existence  of  the  transfer- 
ence. Both  would  be  erroneous.  The  work  of  the  physician  is 
not  increased  by  the  transference;  it  may  be  indifferent  to  him 
whether  the  resurrected  impulse  of  the  patient  has  to  be  overcome 
while  it  is  attached  to  himself  or  to  another  person.  Further,  the 
transference  in  the  treatment  imposes  no  new  task  upon  the 
patient  which  he  would  not  otherwise  have  performed.  If  recov- 
eries from  the  neuroses  also  come  about  through  other  influences, 
still,  it  is  possible  only  because  of  such  a  latent  working  transfer- 
ence. The  difference  is  on?.y  that  the  patient  ordinarily  merely 
produces  affectionate  and  friendly  transference  in  his  recovery. 
In  the  psycho-analysis,  on  the  contrary,  all  impulses  corresponding 
to  a  change  in  motivation,  even  hostile  ones  (negative  transfer- 
ence), are  awakened,  transferred  to  the  physician  and  by  being 
made  conscious  aid  the  treatment ;  thus  the  transference  is  always 
destroyed  for  good.  The  transference  which  is  destined  to 
become  the  greatest  hindrance  to  psycho-analysis  is  the  mightiest 
means  of  help  when  one  succeeds  in  detecting  it  immediately  and 
translating  it  to  the  patient.  One  should  not  conclude  that  the 
transference  is  a  sort  of  lasting  attachment  of  the  patient  to  the 
physician,  as,  for  example,  has  been  the  reproach  of  hypnotic 
therapy.  On  the  contrary,  it  has  already  been  asserted  that  the 
patient  must  be  constantly  informed  of  it  and  that  the  physician 
should  meet  the  patient  with  a  certain  cool  aloofness  and  must 
really  endeavor^^*  at  the  close  of  the  analysis  to  leave  him  as  much 
a  stranger  to  the  patient  as  he  was  before  the  treatment  began; 
in  this  way,  not  only  the  genuine  cure  of  the  patient  but  also  his 
own  independence  is  attained  The  one  or  another  symptom 
which  still  persists  often  disappears  entirely  and  for  good  only 
after  the  complete  dissolution  of  the  transference-relation. 

"*A  similar  transference  on  the  part  of  the  physician  (reversed  trans- 
ference) is  to  be  avoided  by  self -analysis. 
10 


130  FREUD  S  THEORY  OF   THE   NEUROSES 

Against  this  method  of  Freud's  loud  dissenting  voices  have 
repeatedly  been  raised,  characteristically  though  only  by  those  who 
have  never  used  the  method  at  all  or  only  with  unsatisfactory 
results.  For  everyone  who  has  gained  by  continued  contact  with 
neurotics  an  intimate  insight  into  the  hysterical  mind  must  have 
been  thereby  convinced  of  the  effectiveness  of  the  Freudian 
therapy.  No  one  can  escape  the  convincing  evidence  of  the  erotic 
complexes  always  active  in  the  foreground  nor  the  accompanying 
powerful  resistances  against  these  becoming  conscious.  The 
justice  of  these  empiric  impressions  is  suited  to  banish  the  last 
doubt  of  the  existence  of  the  unconscious  and  its  specific  content. 

The  objections  of  the  critics  arise  not  so  much  from  intimate 
knowledge  as  from  a  priori  dislike  of  the  subject  of  sexuality 
which  must  inevitably  be  dealt  with  in  the  etiology  of  these  patho- 
logical conditions.  These  same  opponents  are  also  quite  unjustly 
indignant  over  the  therapy  in  respect  to  the  fear  that  it  may  accom- 
plish the  seduction  of  the  patient  and  by  dealing  with  sexual 
themes  and  a  subjectivmus  which  can  only  injure  them.  This  kind 
of  pretended  suggestion  is,  however,  nowhere  so  impossible  as  in 
psycho-analysis  itself,  where  the  free-flowing  associations  of  the 
patient  show  the  way  for  the  progress  of  the  treatment.  On  the 
contrary,  the  psycho-analyst  knows  that  the  analytic  work  stops 
immediately  the  moment  the  physician  seeks  to  suggest  a  wrong 
or  forced  solution.  The  skillful  psycho-analyst  will  in  general 
limit  himself  as  far  as  possible  to  the  passive  role  of  listener. 
Then  the  neurotic  patient  himself  often  brings  forward  his  sexual 
and  erotic  phantasies  and  one  needs  only  once  to  see  the  feeling 
of  relief  on  the  patient's  part  who  has  for  the  first  time  accused 
hunself  before  a  judge  who  understands,  in  order  to  be  certain 
that  there  can  be  no  question  of  suggestion.  Freud  has  never 
insisted,  as  some  superficial  reviewers  believe,  upon  forcing  a 
free  indulgence  of  the  sexual  appetite.  He  asserts,  rather,  that 
the  recommendation  of  sexual  activity  to  psychoneurotics  is  mostly 
to  be  considered  bad  counsel,  because  in  the  mechanism  of  the 
neurosis  not  merely  the  sexual  need  and  deprivation  come  into 
play.  The  other  just  as  important  and  indispensable  factor  which 
is  all  too  readily  forgotten  is  the  sexual  disinclination  of  neurotics, 
their  incapacity  for  love,  that  psychic  trait  on  which  the  repres- 
sion rests;  it  is  from  the  conflict  between  these  two  tendencies  that 


METHOD  OF  INVESTIGATION  AND  TREATMENT  I3I 

the  neurotic  malady  develops.  The  psycho-analytic  treatment 
aims  not  at  all  at  freeing  the  instincts  from  the  repression,  so 
that  they  may  be  indulged  unhampered,  but  has  in  view  the  bring- 
ing of  the  patients  to  the  point  where  they  can  control  the  same, 
partly  by  conscious  mental  forces,  partly  by  conducting  it  to  a 
higher  and  therefore  unobjectionable  goal  (sublimation).  The 
fear  occasionally  expressed  that  the  unchaining  of  the  suppressed 
evil  instincts  may  bring  injury  becomes  groundless  through  the 
experience  that  the  psychic  and  somatic  power  of  such  instinctive 
impulses  is  only  weakened  by  bringing  them  into  consciousness. 

If  it  is  further  objected  that  there  is  a  danger  to  the  indi- 
vidual as  well  as  to  society  in  discussing  the  sexual  theme  in  its 
widest  extent  and  in  all  detail  during  the  psycho-analytic  treat- 
ment, that  the  physician  has  no  right  to  penetrate  into  the  sexual 
secrets  of  his  patients,  that  he  may  wound  their  modesty — espe- 
cially of  the  women — through  such  gross  examination,  that  his 
awkward  hand  may  disturb  family  peace,  that  he  may  destroy  the 
innocence  of  young  persons  and  encroach  upon  parental  authority, 
acquire  disturbing  knowledge  of  private  affairs  of  adults  and  dis- 
turb his  own  relation  to  the  patients,  it  may  be  answered :  This  is 
the  language  of  an  unworthy  prudery  of  the  physician  which 
imperfectly  covers  his  incompetency  with  bad  arguments.  If 
agencies  from  the  sexual  life  are  recognized  as  really  causing 
disease,  then  the  development  and  discussion  of  these  agencies 
hereby  falls  without  further  thought  into  the  duty  of  the  physi- 
cian. The  wounding  of  modesty  of  which  he  may  be  guilty  is 
no  different  and  no  worse  than  he  would  inflict  if  in  order  to  heal 
a  local  affection  of  the  female  genitals  he  made  a  digital  or  visual 
examination  which  the  school  imposes  upon  him  as  a  duty. 

Occasionally  one  also  hears  the  objection  to  the  psycho- 
analytic treatment,  which  must  be  classed  as  almost  malevolent, 
that  the  psycho-analytic  treatment  oftener  than  any  other  injures 
the  patient,  indeed  may  occasion  suicide.  So  far  as  it  is  not  direct 
personal  hostility  which  dictates  this  reproach,  it  is  the  resistance 
against  something  new  which  forgets  that  hydrotherapy  and  other 
therapeutic  methods  sometimes  treat  as  a  neurosis,  conditions 
which  are  really  beginning  psychoses.  Also,  one  will  judge  other- 
wise if  one  has  got  in  the  habit  of  charging  to  the  treatment 
everything  which  happens  during  the  treatment  of  a  case  of  dis- 


132  FREUD  S  THEORY   OF   THE   NEUROSES 

ease.  Occasionally,  apparent  retrogressions  in  the  neurotic  patho- 
logical condition  will  appear  through  acute  conditions  in  no  way 
chargeable  to  the  treatment  but  which  are  in  most  cases  necessary 
and  healthful  eruptions  of  the  unconscious,  strong  reaction 
phenomena,  under  which  the  deviation  from  the  normal  is  cor- 
rected, the  mental  obsession  is  broken.  In  general,  the  state  of 
health  during  the  treatment  is  no  standard  of  measure  for  the 
final  results. 

The  resistance  against  this  novel  and  not  easily  acquired 
method  of  treatment  manifests  itself  also  in  a  certain  mischievous 
joy  which  is  shown  when  occasionally  results  are  not  immediately 
forthcoming  or  are  absent  altogether.  Now  it  happens  often  as 
related  that  the  result  does  not  follow  immediately  on  the  termina- 
tion of  the  treatment  but  that  the  condition  of  the  patient  only 
first  approaches  health  some  time  after  the  end  of  the  analysis 
and  indeed  from  the  time  at  which  the  relations  to  the  physician 
are  completely  and  smoothly  dissolved.  The  delay  in  the  cure  or 
improvement  seems  in  general  to  be  essentially  conditioned  on  the 
earlier  described  transference-relation.  Moreover,  the  results  in 
the  treatment  of  the  neuroses  are  often  shattered  by  affairs  in  the 
external  life  of  the  patients,  the  healthful  changing  of  which  lies 
beyond  the  power  of  the  physician.  Against  the  recovery,  stand 
many  kinds  of  unconscious  motives,  since  the  patients  fled  to  the 
neurosis  and  thus  many  a  symptom,  in  spite  of  an  analysis  which 
has  progressed  far,  is  not  to  be  got  rid  of  because  of  this  obstinacy 
of  such  a  "secondary  function"  in  mental  life  which  nourishes 
such  a  mental  disturbance.  He  who  wishes  to  make  the  patient 
well  stumbles  to  his  astonishment  upon  a  great  resistance  which 
teaches  him  that  the  patient  is  not  sincere  in  wanting  to  get  rid  of 
his  suffering.  In  the  battle  of  these  disease  motives,  as  Freud 
calls  them,  lies  quite  generally  the  weakness  of  any  therapy  and 
also  of  the  psycho-analytic.  Thus,  for  example,  when  a  neglected 
wife,  or  one  who  feels  herself  neglected,  knows  how  to  gain 
through  sickness  sympathy,  attention  and  love  from  her  husband 
which  she  lacked,  by  the  relinquishment  of  which,  the  previous 
dull  married  life  would  begin  again.  In  general,  it  is  a  pre- 
requisite of  every  possibility  of  cure  that  the  patient  suffers  from 
his  symptoms  or  better  said  suffers  more  than  what  he  gains  from 
his  sickness.    An  homosexualist,  a  fetichist,  a  pervert  will  as  a 


METHOD  OF  INVESTIGATION  AND  TREATMENT  1 33 

rule  absolutely  refuse  to  give  up  his  pathological  tendencies. 
Whether  this  case  occurs  from  external  or  internal  causes,  how- 
ever, taking  into  consideration  the  least  influenced  cases  as  well 
as  the  most  favorably  influenced,  one  must  still  consider  the 
psycho-analytic  therapy  the  method  of  choice  in  such  abnormal 
conditions.  It  should  be  expressly  mentioned  that  a  psycho- 
analytic treatment,  though  incomplete,  may  show  relatively  good 
results  by  making  the  patient  cheerful  and  capable  of  work  and 
play.  And  even  if  the  patient  is  not  completely  restored  to  health, 
still  he  has  usually  learned  to  partially  diminish  his  symptoms  by 
self-interpretation  and  to  control  his  unconscious. 

From  all  this,  one  sees  that  the  method  of  psycho-analysis 
makes  high  demands  both  on  the  patient  and  the  physician ;  from 
the  former,  it  demands  the  offering  of  complete  sincerity,  a  con- 
siderable amount  of  time  and  hence  a  good  deal  of  expense;  from 
the  physician,  it  also  demands  much  time  and  therefore  makes 
desirable,  as  well  as  because  of  the  tediously  learned  and  difficult 
technique,  a  specialization  in  this  field.  It  is  therefore  intelligible 
that  one  might  prefer  methods  which  promised  cure  more  con- 
veniently and  in  shorter  time.  At  first  there  came  into  the  hands 
of  the  psycho-analyst  mostly  patients  who  had  already  sought  all 
other  methods  in  vain  and  had  spent  years  in  sanitaria.  These 
patients,  however,  are  in  about  the  condition  of  sufferers  from 
tuberculosis  who  have  cavities  in  their  lungs;  treated  as  light 
catarrh  of  the  apices,  they  would  have  yielded  dazzling  results. 
It  should  not  be  said  that  psycho-analysis  cannot  heal  severe  cases 
of  neurosis — the  technique  has  been  founded  and  proven  on  just 
such  cases — nevertheless,  these  cases  must  come  at  the  right  time 
into  the  hands  of  suitable  psycho-analysts.  There  is  still  lacking 
and  will  be  for  a  long  time  a  sufficiently  widespread  recognition  of 
the  nature  and  significance  of  psychoneurotic  maladies,  both 
among  medical  circles  and  the  laity,  and  herein  lie  the  essential 
difficulties  which  now  oppose  the  psycho-analytic  method  and  not, 
as  is  still  always  supposed,  in  the  thing  itself.  The  psychoneuroses 
as  a  class  are  not  at  all  mild  diseases,  as  in  greatest  part  the  physi- 
cians and  more  yet  the  laity  suppose ;  the  latter  is  firmly  convinced 
of  the  superfluousness  of  all  these  disease  phenomena  and  there- 
fore neither  brings  a  patience  for  the  course  of  the  disease  nor  a 
special  readiness  to  sacrifice  to  the  therapy.    The  sincerity  of  the 


134  FREUD  S  THEORY  OF  THE   NEUROSES 

physicians  and  the  accommodation  of  the  laity  will  be  established 
for  the  psychoneuroses  when  it  shall  be  known  that  a  severe 
neurosis,  in  its  importance  for  the  afflicted  individual,  is  not  one 
whit  behind  any  of  the  feared  general  diseases  and  that  the  resto- 
ration from  years  of  incapacitating  sufferings,  corresponding  in 
degree  to  their  energies,  is  not  to  be  expected  in  a  few  weeks  nor 
from  a  treatment  which  causes  no  inconvenience.  The  psycho- 
analytic therapy  has  the  triumph  of  having  made  permanently 
capable  of  existence  a  gratifying  number  of  all  the  severest  cases, 
and  against  these  results  all  objection  is  insignificant.  Hence  it  is 
obvious  that  the  analytic  treatment  in  the  mild  periodically  appear- 
ing maladies  or  in  the  initial  stages  of  severer  cases  can  obtain 
brilliant  and  often  surprisingly  rapid  and  lasting  results;  it  is 
only  a  question  of  time  and  of  the  increasing  knowledge  of  these 
maladies  when  psycho-analysis  will  be  able  to  prove  its  great 
cultural  and  social  importance  as  a  real  prophylactic  method 
(education,  enlightenment). 


CHAPTER  IX 

GENERAL  PROPHYLAXIS   OF  THE  NEUROSES 
Cultural  Sexual-Morality.    Sexual  Education,    Sexual  Enlightenment. 

Physicians  are  accustomed  to  being  unsatisfied  with  the  mere 
curing  of  a  disease  and  to  seek  the  ideal  condition  in  its  preven- 
tion. This  important  point  must  be  discussed :  How  do  the  new 
facts  concerning  the  etiology  of  the  neuroses  affect  their  prophy- 
laxis? Freud  has  expressed  himself  in  detail  on  some  of  these 
points  in  his  article  "  Die  kulturelle  Sexualmoral  und  die  modeme 
Nervositat ""^  (Cultural  Sexual-morality  and  Modern  Nervous- 
ness) and  come  there  to  the  consoling  opinion  that  the  frequency 
of  nervous  maladies  in  our  time  is  not  due  to  the  progress  of 
civilization  and  the  acquisitions  of  technical  science  nor  to  the 
complex  and  rushing  manner  of  life  of  civilized  men,  as  has  been 
generally  held.  It  is  not  so  much  that  this  widespread  view  is 
erroneous  as  that  it  is  inadequate  to  explain  the  peculiarities  of 
the  phenomena  of  the  nervous  disturbances  and  leaves  out  of 
account  the  most  important  of  etiological  factors.  If  one  looks 
away  from  the  more  indefinite  kinds  of  "being  nervous"  and 
limits  his  attention  to  the  genuine  forms  of  nervous  maladies,  he 
finds  the  injurious  influence  of  civilization  really  narrowed  down 
to  the  injurious  suppression  of  the  sexual  life  of  civilized  people 
(or  classes)  through  the  prevailing  cultural  sexual  morality.  The 
Freudian  investigations  have  shown  that  culture  has  been  quite 
generally  built  upon  the  suppression  of  the  instincts.  Experience 
teaches,  however,  that  for  most  people  there  is  a  limit  beyond 
which  their  constitution  cannot  follow  cultural  demands.  It  is  one 
of  the  most  manifest  social  injustices  that  the  cultural  standard 
should  demand  of  all  persons  the  same  conduct  of  the  sexual  life 
which  is  possible  for  some  on  account  of  their  organization  with- 
out trouble,  while  on  others  it  imposes  the  greatest  mental  hard- 
ship. Really,  in  this  way,  the  relatively  large  number  of  perverts 
is  occasioned.    Many  idealistic  reformers  would  even  sharpen  still 

«'  Lit.  No.  30. 

135 


136  freud's  theory  of  the  neuroses 

more  the  sexual  morality  by  demanding  from  individuals  of  both 
sexes  abstinence  before  marriage  and  lifelong  abstinence  for  all 
who  cannot  enter  into  a  legitimate  marriage.  To  such  an  one,  we 
may  answer  in  opposition  that  the  task  of  conquering  such  a 
mighty  impulse  as  the  normal  sexual  instinct  can  take  all  the 
strength  of  a  man.  The  conquering  through  sublimation,  the 
transference  of  the  forces  of  the  sexual  instinct  from  sexual  ends 
to  higher  cultural  aims,  succeeds  in  only  a  minority ;  most  of  the 
others  either  become  neurotic  or  come  to  other  injury.  Experi- 
ence shows  that  the  majority  of  persons  composing  our  society 
are  not  constitutionally  adapted  to  endure  abstinence.  Those 
who  would  become  ill  under  a  more  liberal  sexual  limitation 
become  sick  just  so  much  earlier  and  so  much  more  intensely 
because  of  the  demands  of  our  present-day  cultural  sexual  moral- 
ity, for  against  the  menace  of  a  normal  sexual  impulse  through  bad 
heredity  and  disorders  of  development,  we  know  no  better  secur- 
ity than  sexual  gratification  itself.  The  more  anyone  is  predis- 
posed to  a  neurosis,  the  worse  he  bears  abstinence.  The  dammed-up 
libido  is  really  placed  in  a  condition  to  hunt  out  any  weak  place 
which  is  seldom  lacking  in  the  sexual  life,  there  to  break  through 
into  neurotic  substitute  gratification  in  the  form  of  symptoms. 
He  who  knows  how  to  penetrate  into  the  conditions  of  nervous 
maladies  soon  becomes  convinced  that  the  increase  of  nervous 
diseases  in  our  society  arises  from  the  increase  of  sexual  limita- 
tions. In  the  vast  majority  of  cases,  the  struggle  against  sen- 
suality saps  the  available  energy  of  character,  and  this  just  at  a 
time  when  the  young  man  needs  all  of  his  powers  to  win  his  lot 
and  place  in  society.  On  the  other  hand  there  is  the  onanism, 
often  continued  into  the  adult  years,  and  when  treating  the 
question  of  abstinence,  one  distinguishes  much  too  little  two 
forms  of  the  latter:  the  refraining  from  all  sexual  activity  and 
the  refraining  from  sexual  intercourse  with  the  opposite  sex. 
Many  persons  who  boast  of  abstinence  from  the  other  sex  have 
accomplished  this  only  by  the  aid  of  masturbation.  Further,  this 
corresponds  in  no  way  to  the  ideal  demands  of  cultural  sexual 
morality  and  therefore  drives  the  young  man  into  the  same  con- 
flict with  the  educational  ideal  which  he  would  escape  through 
abstinence.  It  further  ruins  the  character  in  more  ways  than 
one,  chiefly  however,  because  the  sexual  activity  of  a  man  is  a 


GENERAL   PROPHYLAXIS   OF   THE   NEUROSES  1 3/ 

model  for  his  whole  way  of  reacting  in  the  world  (psycho-sexual 
parallelism).  To  one  who  has  energetically  won  his  sexual  object, 
we  give  credit  for  similar  reckless  energy  in  the  pursuit  of  other 
goals.  On  the  other  hand,  he  who  for  various  reasons  renounces 
the  gratification  of  his  strong  sexual  instinct  will  also  be  rather 
conciliatory  and  resigned  than  energetic  in  other  affairs  of  life. 
Even  as  complete  an  abstinence  as  possible  during  adolescence  is 
not  a  young  man's  best  preparation  for  marriage.  The  suppres- 
sion of  everything  sexual,  this  applies  especially  to  the  strict  edu- 
cational rules  for  girls,  as  Freud  has  expressed  it,  is  frequently 
so  well  accomplished  and  carried  so  far  that  the  sexual  instinct, 
after  being  released,  seems  to  have  suffered  lasting  injury. 

Further,  the  sexual  intercourse  in  legitimate  wedlock  offers 
no  full  indemnity  for  the  limitations  before  marriage,  chiefly 
because  that  very  frequently  from  cultural  and  material  reasons, 
the  marriage  must  be  satisfied  with  a  limited  number  of  concep- 
tions, hence  after  a  few  years,  the  marital  intercourse  is  limited 
by  all  those  measures  directed  at  the  prevention  of  pregnancy,  the 
sexual  satisfaction  is  spoiled,  the  finer  sensibilities  of  both  parties 
disturbed  or  where  an  intolerance  against  these  measures  exists, 
the  health  suffers.  It  is  especially  the  woman  who,  under  such 
marriage  conditions,  may  become  most  severely  ill  and  endure  for 
life  the  saddening  neurosis.  Marriage  has  thus,  under  present 
cultural  conditions,  long  ceased  to  be  a  panacea  for  the  nervous 
diseases  of  women;  and  if  we  physicians  still  always  recommend 
it  in  such  cases,  we  know  that  on  the  contrary,  a  girl  must  be  really 
healthy  to  stand  marriage  and  strongly  advise  our  men  patients 
against  marrying  a  girl  who  has  been  "  nervous  "  before  marriage. 
For  it  is  also  a  grievous  discovery  for  the  man  to  get  a  constantly 
anesthetic  woman  in  marriage,  a  very  frequent  result  of  the 
present  generally  approved  strict  and  over-moral  education  of 
girls.  The  undersensitive  wife  and  the  husband,  because  of 
chastity  and  masturbation  of  little  potency  and  especially  fre- 
quently suffering  from  ejaculatio  praecox,  make  a  picture  of  a 
modern  "  nervous  "  marriage  where  the  incomplete  sexual  gratifi- 
cation brings  on  that  nervousness  and  irritability  which  destroys 
the  family  life.  The  neurotic  wife,  ungratified  by  her  husband, 
is  as  a  mother  overaffectionate  and  overanxious  toward  the  child 
to  whom  she  transfers  her  craving  for  love,  thereby  awakening 


138  freud's  theory  of  the  neuroses 

in  him  sexual  precocity.  The  bad  agreement  between  the  parents 
excites  the  emotional  life  of  the  child  and  causes  it  in  its  tenderest 
years  to  feel  intensely  love,  hate  and  jealousy.  The  strict  edu- 
cation which  tolerates  no  kind  of  expression  of  the  early  awakened 
sexual  life  assists  the  suppressing  power  and  the  conflict  at  this 
age  contains  everything  necessary  for  the  causation  of  a  lifelong 
nervous  invalidism. 

Individual  prophylaxis  must  be  instituted  in  earliest  childhood 
as  the  whole  etiology  of  the  neuroses  teaches ;  according  to  Freud, 
this  is  a  self-evident  fact.  The  child  cannot  be  too  carefully 
guarded  from  every  evil  influence  from  other  children  as  well  as 
from  adults,  especially  nurses,  who  are  often  guilty  of  abuse  and 
seduction  of  little  children.  A  constant  oversight  of  the  child 
and  an  environment  in  no  way  precarious  must  be  most  emphat- 
ically recommended.  That  the  parents  themselves  in  their  igno- 
rance, by  excessive  aflfection,^"^  boisterous  caresses,  all  too  fre- 
quent taking  the  child  into  bed  with  themselves,  prematurely 
awaken  his  instincts  and  thereby  bring  injury  upon  him  may  be 
again  asserted.  That  excessive  masturbation  must  be  combated 
at  the  right  time  has  already  been  emphasized.^**^  This  should, 
however,  not  convey  the  impression  that  the  avoidance  of  sexual 
experiences  which  finally  bring  enlightenment  can  by  itself  pre- 
vent the  formation  of  neuroses.  It  must  much  rather  be  expressly 
emphasized  that  it  is  of  decisive  importance  for  the  prophylaxis 
that  no  too  rigorous  demands  for  repression  be  imposed  on  the 
children,  especially  on  those  with  bad  heredity.  For  the  relaxa- 
tion of  the  repression  at  the  right  time  corresponding  to  the 
demands  of  life  renders  continuance  in  health  possible.  In  this 
sense,  Freud  is  a  supporter  of  a  systematic  enlightenment  of 
children.^''^  The  necessity  for  this  lies  in  the  fact  that  children 
often  show  great  interest  and  understanding  in  the  affairs  and 
problems  of  the  sexual  life.  This  finds  expression  not  only  in  the 
instinct  for  sexual  investigation  of  children  which  leads  to  the 
already  mentioned,  sometimes  very  disastrous  birth  and  creation 
phantasies  but  also  in  masked  form  in  their  untiring  questioning, 

"•Compare  A.  Adler,  "Das  Zartlichkeitsbediirfnis  des  Kindes,"  Mo- 
natshefte  f.  Pddagogik  u.  Schulpolitik,  1908. 

'"Compare  the  detailed  discussion  of  the  problem  of  onanism  under 
neurasthenia  (Chapter  II). 

"'Lit.  No.  26. 


GENERAL  PROPHYLAXIS  OF  THE   NEUROSES  1 39 

which  education  has  to  satisfy  intelligently.  The  fear  that  the 
child  may  be  enlightened  prematurely  is  entirely  ungrounded; 
for  when  the  child  once  begins  to  inquire,  it  has  already  busied 
itself  a  long  time  most  intimately  with  the  sexual  problem ;  experi- 
ence teaches  that  it  is  injudicious  either  to  wish  to  silence  or  lead 
into  false  channels  this  interest  of  the  child  once  it  is  awakened. 
To  wish  to  hold  back  the  sexual  instinct  of  the  child  through 
such  concealment  could  only  lead  to  his  later  learning  to  condemn 
everything  sexual  as  something  vulgar  and  abhorrent.  If  one 
seeks  to  deceive  them  through  false  information  as  the  stork 
legend,  etc.,  then  when  they  penetrate  behind  this  untruthfulness 
of  the  parents  or  teacher,  they  lose  trust  and  respect  for  them  and 
can  often  receive  mistrust  as  a  character  trait  for  their  whole 
lives.  The  manner  of  sexual  enlightenment  Freud  has  repre- 
sented as  a  gradually  progressive  and  really  uninterrupted  instruc- 
tion for  which,  in  place  of  the  parents  who  are  as  yet  unqualified 
for  such  a  task,  the  school  must  take  the  initiative.  The  most 
important  point  in  this  is  that  the  children  should  never  get  the 
idea  that  one  wishes  to  make  the  affairs  of  the  sexual  life  any 
more  of  a  secret  for  them  than  anything  else  which  is  not  yet 
comprehensible  to  their  understanding.  That  there  is  opportunity 
for  the  public  teacher  and  indeed  for  the  clergy  to  make  use  of 
the  Freudian  knowledge  for  the  good  of  their  adherents  is  shown 
by  the  publications  of  the  Zurich  pastor  Pfister.^^^  Unfortunately, 
the  parents  as  well  as  the  teachers  of  to-day  still  lack  the  neces- 
sary knowledge  of  sexual  matters,  especially  in  relation  to  neurotic 
disturbances.  Especially  do  our  parents  and  educators  lack  the 
candor  to  discuss  the  sexual  problem  from  which  they  in  great 
part  openly  suffer  with  the  children;  consequently  they  lack  the 
possibility  of  guarding  the  latter  against  sexual  injuries  and  of 
explaining  to  them  in  sufficient  manner  all  allied  themes.    A  child 

"*  Oskar  Pfister,  "  Psychoanalytische  Seelsorge  und  experimentelle 
Moralpadagogik,"  Protestantische  Monatshefte,  13th  year,  part  i,  M. 
Heeksius,  Leipzic,  1909.  Same,  "Ein  Fall  von  psychoanalytischer  Seel- 
sorge und  Seelenheilung,"  Monatschrift  "  Evangelische  Freiheit,"  9th  year, 
Tubingen,  J.  C.  B.  Mohr,  1909.  Same,  "  Die  Psychoanalyse  als  wissen- 
schaftliches  Prinzip  und  seelsorgerliche  Methode,"  Ebenda,  loth  year, 
1910.  Dr.  A.  Muthmann  also  sought  to  interest  the  clergy  in  an  article 
"  Psychiatr.-theolog.  Grenzf  ragen,"  Halle  a.  d.  Saale,  Karl  Marhold,  1907. 


I40  FREUD  S  THEORY  OF  THE  NEUROSES 

who  is  ignorant  of  sexual  matters  will  have  quite  a  different  fate 
from  one  who  has  been  instructed  in  these  things.  We  perceive 
therefore,  that  the  education  in  the  affairs  of  sex  is  of  great 
importance  not  only  in  the  prevention  of  the  neuroses  but  also 
for  the  whole  character  development  of  the  child.  Therefore, 
sexual  education^*"  is  essentially  the  fundamental  problem  of 
education  and  cannot  be  separated  from  the  question  of  sexual 
enlightenment.  How  the  education  should  begin  or  how  to  avoid 
injurious  results  which  have  already  occurred  is  a  subject  on 
which  Freud  has  not  expressed  himself  in  detail,  since  he  con- 
sidered his  field  to  be  rather  investigation  and  therapeutics  than 
pedagogy  and  reformation.  The  three  following  chief  view 
points  for  sexual  education  in  general  may  be  deduced  from 
Freud's  works :  In  a  first  period,  the  education  should  vigorously 
aid  the  suppression  of  the  normally  occurring  instinctive  impulses 
and  the  repression  of  wrong  (perverse)  impulses  of  the  growing 
child,  thus  preventing  wrong  tendencies  and  disturbances  of  de- 
velopment ;  in  a  later  period,  it  would  have  to  interfere  positively 
and  educate  the  child  chiefly  through  love;  in  a  third  period,  the 
grown  up  child  would  with  the  aid  of  his  own  parents  free  him- 
self from  their  authority  and  establish  his  psychic  and  social 
individuality. 

If  the  prophylaxis,  however,  is  to  become  effective  and  far- 
reaching,  wider  circles  must  be  interested  in  the  problem.  For  in 
affairs  of  prophylaxis,  the  individual  is  almost  powerless.  The 
whole  body  of  citizens  must  acquire  an  interest  in  the  subject  and 
give  their  consent  to  the  creation  of  generally  observed  regula- 
tions. At  present,  we  are  far  removed,  however,  from  a  condition 
which  would  promise  a  remedy  and  can  therefore  justly  make  our 
civilization  and  cultural  morality  answerable  for  the  spread  of  the 
neuroses.  There  must  be  a  great  change  of  mind.  The  opposition 
of  a  generation  of  physicians  who  no  longer  recall  their  youth 
must  be  broken.  The  haughtiness  of  the  fathers  who  do  not 
gladly  descend  to  the  level  of  ordinary  mortals  in  the  eyes  of  their 
children  must  be  overcome,  the  foolish  bashfulness  of  the  mothers 
must  be  combated,  for  whom  it  now  seems  like  an  inscrutable  and 
undeserved  decree  of  fate  that  their  children  have  become  nerv- 

^'* Compare  A.  Adler,  "Das  sexuelle  Problem  in  der  Erziehung,"  Die 
neue  Gesellschaft,  1905. 


GENERAL   PROPHYLAXIS  OF  THE   NEUROSES  I4I 

ous.  "  Before  everything  else,  however,  there  must  be  opened  in 
the  general  thought  a  chance  for  the  discussion  of  the  sexual 
problem;  one  must  be  able  to  speak  of  these  things  without  being 
pronounced  a  disturber  of  the  peace  or  a  delver  in  the  vulgar 
instinct.  And  there  remains  enough  work  here  for  a  century  in 
which  our  civilization  must  learn  to  live  according  to  the  demands 
of  our  sexuality.""^ 

"'Lit.  No.  II. 


CHAPTER  X 

APPLICATION   OF  PSYCHO-ANALYSIS 

Importance  of  Psycho-Analysis  for  Medicine.  Importance  for  the 
Psychology  of  Normal  Individuals  and  for  Normal  Psychology  (Uncon- 
scious, Dream,  Wit).  Psychopathology  of  Everyday  Life.  Elucidation  of 
the  Psychology  of  Psychopaths,  Criminals,  Artists,  Poets  and  Geniuses 
(Characterology).  Importance  for  the  History  of  Culture  and  Folk- 
Psychology. 

It  is  an  indisputable  service  of  Freud's  to  have  elaborated 
psycho-analysis  to  a  method  which  is  not  only  able  to  disclose  the 
pathogenesis  and  content  of  mental  disorders  but  is  also  valuable 
for  their  treatment.  It  cannot  be  rejected  as  Utopian  to  believe 
that  when  the  fundamental  principles  of  the  neuroses  as  revealed 
by  Freud  shall  have  become  for  the  general  good  a  part  of  medical 
knowledge  and  thereby  indirectly  a  part  of  universal  knowledge, 
the  frequency  of  the  neuroses  may  be  lessened.^'^  The  psycho- 
analytic recognition  of  the  nature  of  these  maladies,  of  their 
psycho-sexual  root  as  well  as  the  means  of  prophylaxis  to  which 
they  point,  will  likewise  work  together  to  allow  the  neuroses  to 
appear  only  in  plain  form.  Individuals  of  neurotic  disposition 
will  have  to  renounce  the  representation  of  their  symptoms  after 
the  origin  and  symbolism  of  these  shall  have  become  trans- 
parent.^®^ Perhaps  indeed,  psycho-analysis  may  succeed  in 
destroying  the  germ  of  the  neurosis  in  childhood  when  the 
teacher,  entrusted  with  the  chief  points  of  the  theory,  aids  in  the 
prevention.  Psycho-analysis  is  not,  however,  merely  a  method 
for  investigating  disordered  minds  but  seems  to  be  destined  to 
become  perhaps  the  most  influential  method  of  mental  investiga- 
tion in  general.  Psycho-analysis  yields  such  far-reaching  expla- 
nations of  the  mechanism  of  mental  functioning  that  in  contrast 
to  a  certain  stagnation  in  the  official  psychology  of  the  universities, 

*"  Compare  Chr.  v.  Ehrenfels,  "  Sexuales  Ober-  und  Unterbewusst- 
sein,"  Polii.-anihropolog.  Revue,  II,  Part  6. 

""Compare  Freud,  "Die  zukiinftigen  Chancen  der  Psychoanalyse," 
Lit.  No.  41. 

142 


APPLICATION   OF  PSYCHO-ANALYSIS  143 

it  allows  an  especially  hopeful  outlook.  The  "  hopelessness  of  all 
psychology,"^**  which  P.  J.  Mobius  has  proclaimed,  can  with  a 
certain  degree  of  justification  be  applied  only  to  the  prevailing 
"consciousness-psychology"  (Bewusstseinspsychologie),  while  the 
method  for  investigating  unconscious  mental  processes  inaugu- 
rated by  Freud  affords  an  outlook  which  is  full  of  promise  for  the 
future.  The  precise  psycho-analytic  method  can  replace  the 
speculations  of  metaphysics  which  have  remained  essentially 
unchanged  for  centuries  as  a  kind  of  "  metapsychology."  Psycho- 
analysis has  brought  forward  such  new  and  fundamental  prin- 
ciples regarding  forgetting  and  mental  obsession  (Zwang),  which 
is  so  closely  connected  with  the  theory  of  the  will,  and  in  particular 
has  placed  the  determinism  of  all  mental  processes  on  so  broad  a 
basis"^  that  from  this  point  an  especially  productive  scientific 
period  will  take  its  origin.  It  has  already  placed  the  fundamental 
facts  of  mental  processes  in  a  new  light.  Thus,  of  prime  impor- 
tance, are  revealed  the  eternally  acting  wishes  of  the  mind,  the 
ever-compelling  instinct  and  the  continual  striving  after  pleasure 
as  the  primary  tendencies  of  the  mind.  Alongside  these  are  the 
mechanisms  of  repression,  condensation  and  displacement  dis- 
covered by  Freud;  these  arise  from  the  entirely  new  conception 
concerning  the  investment  of  ideas  with  affects  and  that  the  two 
are  separable ;  further  the  substitute  formations  and  the  sublima- 
tion which  is  so  important  in  the  history  of  culture,  all  these 
afford  valuable  building  stones  in  the  most  diverse  departments 
of  psychology.  Freud  has  thrown  light  into  isolated  departments 
of  general  psychology  by  his  detailed  investigations  into  the 
psycho-pathology  of  everyday  life,  the  technique  of  wit  formation 
and  the  mechanism  of  dream  origin.  He  has  solved  that  ancient 
enigma  of  the  dream  and,  in  opposition  to  the  consciousness- 
psychology,  has  brought  about  the  enthronement  of  the  uncon- 
scious. The  original  perception  of  Freud's  of  the  close  connection 
of  the  development  of  culture  to  the  suppression  and  sublimation 
of  instinct  has  so  much  significance  in  the  history  of  evolution  of 
humanity  and  of  individual  peoples  that  in  this  field  also,  much 
work  and  fruitful  knowledge  is  yielded  by  psycho-analysis.    The 

*•*?.  J.  Mobius,  "Die  Hoffnungslosigkeit  aller  Psychologic."    Mar- 
hold,  Halle  a.  d.  Saale,  2  ed.    1907. 

'"Compare  the  numerous  references  to  the  association  experiment. 


144  FREUD  S  THEORY   OF  THE   NEUROSES 

fact  that  besides  the  life  instinct  of  the  ego,  the  love-instinct  has 
a  far-reaching  primordial  force,  which  cannot  fail  to  injure  the 
individual  if  it  succumbs  in  the  conflict  of  these  two  fundamental 
instincts,  is  likewise  of  great  significance  for  the  development  of 
culture.  It  must  sound  very  consoling  to  men  to  hear  that  degen- 
eration and  nervousness  are  not  inevitable  results  of  cultural 
progress  but  avoidable  and  only  excrescences  of  the  same.  A 
healthy  optimism  and  a  broad  conception  of  life  remaining  natural 
in  spite  of  all  spiritualization  and  refinement  which  will  not  com- 
pletely exclude  all  sensuousness  follow  naturally  this  enlighten- 
ment. The  results  of  Freud's  investigations  sound  a  warning  to 
civilized  man  of  to-day  that  the  original  animal  part  of  his  nature 
is  not  to  be  completely  neglected  and  that  he  must  not  forget  that 
the  attainment  of  pleasure  for  the  individual  is  not  to  be  elimi- 
nated from  the  aims  of  our  culture.""  If  the  suppression  of  the 
sexual  instinct  through  its  peculiar  possibility  of  sublimation,  that 
is  to  say,  through  the  substitution  of  a  more  remote  and  socially 
more  valuable  cultural  aim  for  its  original  goal  promotes  culture, 
still,  a  certain  part  of  its  impulse  has  a  right  to  a  direct  gratifica- 
tion, for  an  excess  of  repression  compels  a  turning  away  from 
reality  and  thereby  the  establishment  of  the  neurosis.  It  should 
be  here  expressly  stated  that  Freud  is  perfectly  clear  on  the  point 
of  the  decisive  role  played  in  life  and  also  in  the  neurosis  by  the 
egotistic  or  ego  instincts  alongside  of  the  sexual  instinct.  The 
Freudian  doctrines  emphasize  the  hitherto  neglected  point  of  view 
of  the  unconscious  mental  life  and  the  libidinous  impulses.  The 
detailed  investigation  of  the  ego  instincts  which  is  still  to  be  done 
in  exhaustive  fashion  would  afford  supplementary  explanations  of 
the  neuroses,  especially  of  the  symptom  formation. 

The  hysterical  mind  has  unveiled  itself  through  psycho- 
anal)^ic  investigation  as  merely  a  distorted  image  of  the  normal 
mind,  for  he  who  remains  healthy  has  to  struggle  with  the  same 
complexes  that  cause  the  neurotic  to  fall  ill  (Jung).  As  under 
certain  combinations  of  conflicting  forces,  the  neurosis  is  the 
outcome  of  the  struggle,  so  under  other  relations  of  these  mutually 
warring  forces,  other  results  may  ensue;  these  are  especially  the 
antisocial  types  of  psychopaths  and  criminals  as  well  as  the  socially 

*"  Compare  the  popular  book  of  P.  J.  Muller,  "  Geschlectsmoral  und 
Lebensgliick."    Copenhagen,  Tilge,  1909. 


APPLICATION   OF  PSYCHO-ANALYSIS  ,    I45 

superior,  as  artists,  poets  and  men  of  genius.  The  character 
analysis  of  the  gifted,  especially  of  artistically  inclined  persons, 
reveals  every  degree  of  combination  between  capability,  perver- 
sion and  neurosis.  The  psychology  of  criminals  has  not  yet  been 
elucidated  but  appears  to  offer  a  favorable  field  of  investigation 
by  this  method.^*^  Psycho-analysis,  especially  in  the  form  of  the 
association  experiment,  has  already  been  seriously  applied  in  legal 
practice  as  a  means  of  determining  the  condition  of  facts  in  the 
detection  of  a  guilty  conscience.^'^  The  meaning  of  different 
peculiar  types  of  men  (odd  characters,  saints,  reformers) ^^'  and 
many  psychopathic  individuals^''"  is  explained  by  this  side  of 
psychological  investigation,  often  in  surprising  fashion.  Like- 
wise, an  illumination  of  occultistic^''^  and  hypnotic^'^^  phenomena 
is  afforded  respecting  the  persons  who  are  interested  in  these 
things.  That  the  genius  is  named  here  cannot  seem  strange  to 
one  who  has  already  gained  an  inner  understanding  of  these  things. 
The  psycho-analytic  investigations  seem  to  justify  the  dictum 
that  the  genius  represents  the  noblest  outcome  of  the  overcoming 
of  an  abnormal  hereditary  tendency,  whence  he  derives  his  close 
relationship  to  the  neurotic.  Rank  has,  in  a  brief  paper,^'''  sought 
to  show  the  relations  of  the  artistic  temperament  to  the  neurosis 
and  came  to  the  conclusion  that  especially  the  poet,  both  in  the 
mechanism  and  also  in  the  ultimate  tendency  of  his  creations, 
stands  very  near  the  psychoneurotic  and  only  by  the  aid  of  his 
artistic  talents  protects  himself  from  the  neurosis.    Stekel^'^*  and 

*"  Compare  Wulffen,  "  Der  Sexualverbrecher."    Berlin,  1910. 

'"Freud,  " Tatbestandsdiagnostik  und  Psychoanalyse,"  Lit.  No.  24. 
Jung,  "  Die  psychologische  Diagnostik  des  Tatbestandes,"  Jur.-psych. 
Grenzfragen,  1906.  Other  literature  in  E.  Rittershaus,  "  Die  Komplex- 
forschung,"  Jour.  f.  Psych,  u.  Neur.,  Vol.  15,  1910. 

*••  Hitschmann,  "Die  Werbekraft  der  Naturheilkunde,"  Wr.  klin. 
Rundschau,  1910. 

'"*Otto  Gross,  "Uber  psychopathische  Minderwertigkeit."  Vienna, 
Braumiiller,  1909.  O.  Pfister,  "  Die  Frommigkeit  des  Graf  en  Ludwig  von 
Zinzendorf,"  Schr.  z.  angew.  Seelenkunde,  No.  8,  1910. 

"'  Jung,  "  Zur  Psychologie  und  Pathologie  sog.  okkulter  Phanomene." 
Leipzic,  O.  Mutze,  1902.  Hitschmann,  "Zur  Kritik  des  Hellsehens,"  Wr. 
klin.  Rundschau,  1910. 

""Ferenczi,  "Introjektion  und  t)bertragung,"  Jahrh.,  I,  2,  1909. 

"» "  Der  Kunstler."    Vienna,  H.  Heller,  1907. 

"*"Dichtung  und  Neurose."    Bergmann,  Wiesbaden,  1909. 

II 


146  freud's  theory  of  the  neuroses 

Sadger  have  undertaken  special  investigations  in  this  direction. 
The  latter  in  particular  has  sought  to  interpret  the  lives  of  the 
individual  poets,  as  C.  F.  Meyer/^^  Lenau,"**  Kleist"''  and  others 
psycho-analytically.  The  first  incitement  to  the  application  of 
information  regarding  the  mind  gained  by  psycho-analysis  to  a 
deeper  penetration  into  the  mind  of  the  poet  was  put  forward  by 
Freud  in  connection  with  the  solution  of  the  dream  problem  in  his 
interpretation  of  Shakespeare's  drama  of  Hamlet"^  in  which  he 
could  reveal,  in  connection  with  the  CEdipus  of  Sophocles,  a 
masked  form  of  the  universal  incest  complex."® 

A  penetrating  glimpse  of  the  secret  strata  of  the  poetic  work 
is  afforded  by  the  analysis  undertaken  by  Freud  of  the  delusions 
and  dreams  in  W.  Jensen's  Gradiva.^®"  It  is  shown  there  that  the 
poet,  without  knowledge  of  dream  and  neurosis  psychology,  can 
still  create  his  bit  of  phantasy  so  that  the  physician  can  analyze  it 
like  a  real  clinical  history.  From  this  follows  the  necessity  for  the 
conclusion  that  the  psycho-analyst  and  the  poet  must  have  worked 
from  the  same  sources,  that  they  elaborated  the  same  subject  but 
each  with  a  different  method;  the  agreement  in  results  seems, 
therefore,  to  warrant  the  conclusion  that  both  have  worked  cor- 
rectly. The  method  of  the  analyst  consists  in  the  conscious  obser- 
vation of  the  abnormal  mental  processes  in  others  in  order  to 
guess  the  rules  and  be  able  to  formulate  them.  The  poet  goes  at 
it  differently:  he  directs  his  attention  to  the  unconscious  in  his 
own  soul,  listens  to  the  possibilities  of  development  of  the  same 
and  allows  it  artistic  expression  instead  of  suppressing  it  by  con- 
scious criticism.  Thus,  he  experiences  out  of  himself  what  the 
analyst  learns  from  others :  namely,  what  rules  the  activity  of  this 
unconscious  must  follow;  but  he  need  not  formulate  these  rules, 
not  once  clearly  recognize  them,  they  are  as  a  result  of  his  intelli- 
gence incorporated  in  his  creations.    The  analyst  develops  these 

"'"Eine  pathographische  Studie."    Bergmann,  Wiesbaden,  1908. 

"•"Aus  dem  Liebesleben  Nik.  Lenaus,"  Schr.  s.  angew.  Seelenk.,  No. 
6,  1909. 

^"  Bergmann,  Wiesbaden,  1910. 

"' Traumdeutung,  2d  ed.,  page  187. 

^"The  detailed  proof  for  this,  E.  Jones  has  brought  forward  in 
"  The  CEdipus-Complex  as  an  Explanation  of  Hamlet's  Mystery  "  (Amer. 
Journal  of  Psychology,  Jan.,  1910). 

^  Schriften  zur  angewandten  Seelenkunde,  Part  I. 


APPLICATION  OF  PSYCHO-ANALYSIS  14/ 

rules  by  analysis  of  the  poems  as  he  has  detected  them  in  cases  of 
real  illness;  the  conclusion  seems  inevitable:  either  both  the  poet 
and  the  physician  have  misunderstood  the  unconscious  in  similar 
manner  or  both  have  understood  it  correctly. 

The  sources  of  the  poetic  phantasy  arise  not  far  from  those  of 
the  dream  and  day-dream  of  people  and  Freud  has  shown  in  his 
lecture  "  Der  Dichter  und  das  Phantasieren  "^^^  (Poet  and 
Phantasy)  that  the  material  of  the  narrating  poet  (romance),  as 
far  as  it  arises  from  free  invention,  betrays  its  genesis  by  its 
analogous  structure  to  the  day-dream.  These  phantasies  are 
indeed,  by  the  poetic  technique  which  in  individual  cases  is  not 
demanded,  divested  of  their  purely  individual  interest  and  trans- 
formed to  general  sources  of  pleasure. 

Recently,  Freud  has  published  a  psycho-analytic  study  on  the 
peculiar  mental  physiognomy  of  one  of  the  greatest  artists,  "  Eine 
Kindheitserinnerung  des  Leonardo  da  Vinci  ""^  (A  Childhood 
Memory  of  Leonardo  da  Vinci),  and  therewith  given  an  example 
of  the  influence  of  psycho-analysis  on  biography.  The  investiga- 
tion gives,  proceeding  from  the  interpretation  of  a  childhood 
phantasy,  an  original  and  surprising  insight  into  the  conditions 
of  the  artistic  work  of  this  universal  genius.  Here  the  attempt  is 
made  anew  to  derive  from  the  exceptional  case  of  one  of  the 
greatest  geniuses  of  mankind  one  of  the  most  important  propor- 
sitions  of  psycho-analytic  science,  namely,  the  fundamental  and 
definite  importance  for  the  whole  course  of  mental  development 
of  all  the  first  impressions  of  childhood,  the  later  force  of  which 
can  be  essentially  weakened  by  no  later  experience,  no  matter  how 
intense.  The  subsequent  effect  is  explained  by  the  fact  that  these 
first  impressions  have  given  sensuous  pleasure.  Infantilism  and 
sexuality,  which  are  disclosed  by  the  Freudian  investigations  as 
the  chief  components  of  the  neuroses,  show  themselves  further  to 
be  the  directing  streams  in  the  development  of  every  character, 
both  of  the  exceptional  (genius)  and  of  the  normal.  Thereby  is 
the  way  prepared  for  a  kind  of  characterology  which  will  perhaps 
be  in  a  position  to  set  up  certain  types  and  to  bring  the  develop- 
ment of  these  into  close  connection  with  quite  definite  expressions 
of  certain  instinctive  activities.     For  such  a  formation  of  final 

*"Lit.  No.  31- 

^Schr.  s.  angew.  Seelenkunde,  No.  7,  1910. 


148  freud's  theory  of  the  neuroses 

character  from  definite  constitutional  instinctive  impulses  and  the 
later  fate  of  these,  Freud  has  laid  down  a  formula  according  to 
which  the  character  traits  which  remain  are  either  unchanged 
continuations  of  original  instincts,  sublimations  of  the  same  or 
reactions  against  them."^ 

It  is  conceivable  that  such  important  results  for  the  compre- 
hension of  mental  life  may  not  remain  limited  to  the  psychology 
of  isolated  individuals  and  it  is  an  indirect  proof  of  the  correctness 
of  the  Freudian  theory  that  these  have  proved  so  very  fruitful  in 
the  field  of  folk-psychology.  In  the  "  Schriften  zur  angewandten 
Seelenkunde"  (Papers  on  Applied  Psychology),  edited  by  Freud, 
are  some  works  along  this  line.  Riklin  could  show  in  "  Wunscher- 
fiillung  und  Symbolik"  that  the  wish-fulfilling  and  symbolism 
which  Freud  had  discovered  in  the  dream  and  neurosis  was  also 
active  in  legends  (part  2,  1907).  Abraham  has  shown  in  a  study 
on  folk-psychology,  "  Traum  und  Mythus"  (Dream  and  Myth) 
(part  4,  1908),  that  the  fundamental  meaning  of  the  CEdipus  tales 
as  given  by  Freud  also  gives  expression  to  the  same  psychological 
facts  in  folk-myths ;  Rank  in  a  limited  group  of  myths,  "  Mythus 
von  der  Geburt  des  Helden"  (Myths  of  the  Birth  of  Heroes) 
(part  5,  1909),  demonstrated  the  value  of  the  detailed  knowledge 
gained  by  psycho-analysis  for  the  deeper  understanding  of  myth 
formation  and  myth  interpretation. 

Further,  Freud  has  endeavored  to  illuminate^®*  from  the 
psycho-analytic  standpoint  the  most  important  performance  of  the 
folk-mind  in  addition  to  the  myth  and  legend  creation,  namely 
religion,  on  the  basis  of  certain  apparent  similarities  between  defi- 
nite obsessional  acts  of  those  with  obsessional  neurosis  and  the 
forms  of  religious  customs,  and  has  come  to  the  conclusion  on 
the  ground  of  certain  agreements  and  analogies  that  the  obses- 
sional neurosis  is  a  pathological  counterpart  of  the  religious  struc- 
ture ;  we  may  call  the  neurosis  an  individual  religious  practice,  the 
religion,  an  universal  obsessional  neurosis.  Here  the  complexes 
in  the  sense  of  Jung  lose  as  you  might  say  their  pathogenic  activ- 
ity **  since  they  become  universal." 

The  individual  root  of  the  belief  in  God  Freud  has  disclosed 
in  the  intimate  connection  with  the  father-complex;  the  personal 

'*Lit.  No.  29. 

"* "  Zwangshandlungen  und  Religionsiibung,"  Lit.  No.  25. 


APPLICATION   OF   PSYCHO-ANALYSIS  149 

God  is  psychologically  no  other  than  an  enlarged  father  and 
psycho-analysis  brings  daily  before  our  eyes  how  youthful  persons 
lose  their  religious  faith  as  soon  as  the  authority  of  the  father  is 
broken  in  them.  Biologically,  religion  goes  back  to  the  helpless- 
ness of  the  little  human  child,  which  when  it  has  later  recognized 
its  weakness  against  the  great  powers  of  life  seeks  to  deny  its 
position  just  as  in  childhood  it  feels  and  seeks  to  deny  its  dis- 
consolateness  by  regressive  renewing  of  infantile  protective  meas- 
ures.^^^  In  ultimate  analysis,  religion  seems  like  the  delusion, 
dream  and  neurosis  to  be  an  attempt  on  the  part  of  us  human 
beings  to  make  up  for  the  deficiency  of  reality  which  we  find  quite 
generally  unsatisfying  by  the  production  of  wish- fulfillment. 

The  brief  resume  given  in  this  chapter  of  the  fruitful  activity 
of  psycho-analysis  applied  to  other  fields  of  mental  science  shows 
that  we  have  here  more  than  a  purely  rnedical  instrument  and 
since  in  all  these  fields  as  yet  only  the  first  beginnings  in  life  have 
been  touched  upon,  so  with  the  constantly  growing  number  of 
co-workers  from  other  fields  of  science,  further  elaboration  is  to 
be  expected. 

"«Lit.  No.  39. 


4 


CHRONOLOGICAL  REVIEW  OF  FREUD'S  WRITINGS^*' 
FROM  1893  TO  1910 

1.  tJber  den  psychischen  Mechanismus  hysterischer  Phanomene.    By  Dr. 

Josef  Breuer  and  Dr.  Sigmund  Freud  in  Vienna.  Neurologisches 
Zentralblatt,  1893,  Nr.  i  and  2,  also  reprinted  as  introduction  to  the 
"  Studien  iiber  Hysterie,"  1895,  and  in  the  "  Sammlung  kleiner 
Schriften  zur  Neurosenlehre  aus  den  Jahren  1893-1906"  (Kl.  Schr. 
I).    F.  Deuticke.    Vienna  and  Leipzic,  1906. 

2.  Quelques  considerations  pour  une  etude  comparative  des   paralysies 

motrices  organiques  et  hysteriques.  Archives  de  Neurologic,  1893, 
Nr.  -JT.    (Also  Kl.  Schr.  I.) 

3.  Die  Abwehrneuropsychosen.     Attempt  at  a  psychological   theory  of 

acquired  hysteria,  many  phobias  and  obsessions  and  certain  halluci- 
natory psychoses.  Neurologisches  Zentralblatt,  1894,  Nr.  10  and  11. 
(Also  Kl.  Schr.  I.) 

4.  t)ber  die  Berechtigung,  von  der  Neurasthenic  einen  bestimmten  Symp- 

tomenkomplex  als  "  Angstneurose "  abzutrennen.  Neurologisches 
Zentralblatt,  189S,  Nr.  2.     (Also  Kl.  Schr.  I.) 

5.  Studien  Uber  Hysterie.    By  Dr.  Josef  Breuer  and  Dr.  Sigmund  Freud. 

Leipzic  and  Vienna,  F.  Deuticke,  1895;  2,  unchanged  edition,  1909. 
Parts  of  Freud's  share  in  this  book  enlarged  by  some  later  papers 
on  hysteria  have  been  translated  into  English  by  Dr.  A.  A.  Brill: 
"  Selected  Papers  on  Hysteria  and  other  Psychoneuroses "  by  S. 
Freud,  Nr.  4  of  the  "  Nervous  and  Mental  Disease  Monograph 
Series,"  New  York,  1910. 

6.  Obsessions  et  Phobies.     Leur  Mecanisme  psychiquc  et  leur  etiologie. 

Revue  neurologique,  HI,  1895.  (Also  Kl.  Schr.  I.)  (German  trans- 
lation: Wiener  kl.  Rundschau,  1895.) 

7.  Zur  Kritik  der  "Angstneurose."    Wiener  kl.  Rundschau,  1895.     (Also 

Kl.  Schr.  I.) 

8.  Weiterc   Bemerkungen   uber  die  Abwehrneuropsychosen.     Neurologi- 

sches Zentralblatt,  1896,  Nr.  10.    (Kl.  Schr.  I.) 

9.  L'heredite  et  I'etiologie  des  Nevroses.    Revue  neurol.,  IV,  1896.     (KL 

Schr.  I.) 

10.  Zur  Atiologie  der  Hysterie.    Wiener  kl.  Rundschau,  1896,  Nr.  22-26. 

(Kl.  Schr.  I.) 

11.  Die  Sexualitat  in  der  Atiologie  der  Neurosen.    Wiener  kl.  Rundschau, 

1898,  Nr.  2,  4.  5,  7.     (Kl.  Schr.  I.) 

"•Compare  also  Abraham's  bibliography  of  Freud's  writings  in  the 
Jahrbuch  fiir  psychoanalytische  und  psychopathologische  Forschungen, 
Vol.  I,  1909. 

150 


REVIEW  OF   FREUD  S  WRITINGS  I5I 

12.  Zum  psychischen  Mechanismus  der  Vergesslichkeit.     Monatsschrift  f. 

Psychiatric  u.  Neurologic,  Vol.  4,  1898.  Reprinted  in  "  Zur  Psycho- 
pathologic  des  Alltagslebens." 

13.  t)ber  Dcckerinnerungen.    Ebenda,  Vol.  6,   1899.     (Also  "AUtag.") 

14.  Die  Traumdeutung.    F.  Deuticke,  Leipzic  and  Vienna,   1900;  2d  en- 

larged edition,  1909. 

15.  Ubcr  den  Traum.    Wiesbaden,  J.  F.  Bergmann,  1901.     (Grenzfragen 

des  Ncrven-  und  Seclcnlebens,  edited  by  Lowenfeld  and  Kurella.) 

16.  Zur     Psychopathologie     des    Alltagslebens.    t)ber     Vergcssen,     Ver- 

sprechen,  Vergreifen,  Aberglaube  und  Irrtum.  Monatsschrift  f. 
Psychiatric  und  Neurologic,  Vol.  10,  1901.  In  book  form:  Berlin, 
S.  Karger,  1904 ;  2d  enlarged  edition,  1907 ;  3d  enlarged  edition,  1910. 
Translated  into  Russian  by  Dr.  B.  Medem,  1910. 

17.  Die  Frcudschc  psychoanalytische  Mcthode.    In:  Lowenfeld,  "  Psychi- 

sche  Zwangserscheinungen,"  1904.     (Kl.  Schr.  I.) 

18.  Uber  Psychotherapie.    Wiener  med.  Pressc,  1905,  Nr.  I.    (Kl.  Schr.  I.) 

19.  Der  Witz  und  seine  Beziehung  zum  Unbewussten.    F,  Deuticke,  Vienna 

and  Leipzic,  1905. 

20.  Drei    Abhandlungen    zur    Sexualtheorie.    F.    Deuticke,    Vienna    and 

Leipzic,  1905.    2d  essentially  unchanged  edition,  1910. 
21.-  Bruchstiick  ciner  Hysterieanalyse.    Monatsschr.  f.  Psychiatric  u.  Neu- 
rologic, Vol.  18,  Parts  4  and  5  1905.     (Kl.  Schr.  II.) 

22.  Meine  Ansichten  iibcr  die  RoUe  der  Sexualitat  in  der  Atiologie  der 

Neurose.  In  Lowenfeld :  "  Sexuallebcn  u.  Ncrvenleiden,"  4th  ed., 
1906.     (Kl.  Schr.  I.) 

23.  Sammlung  kleiner  Schriften  zur  Neuroscnlchre  aus  den  Jahren  1893 

to  1906.    Vienna  and  Leipzic,  F.  Deuticke,  1906,     (Kl.  Schr.  I.) 

24.  Tatbestandsdiagnostik  und  Psychoanalyse.    Archiv  f.  Kriminalanthro- 

pologic  und  Kriminalistik  by  Gross,  Vol.  26,  1906.    (Kl.  Schr.  II.) 

25.  Zwangshandlungen    und    Religionsiibung.      Zeitschrift    f.    Religions- 

psychologic,  Vol.  I,  Part  I,  1907.     (Kl.  Schr.  II.) 

26.  Zur  scxuellen  Aufklarung  der  Kinder.    "  Soziale  Medizin  und  Hy- 

giene," Vol.  II,  1907.     (Kl.  Schr.  II). 

27.  Der  Wahn  und  die  Traume  in  W.  Jensens  "  Gradiva."     Schriften  zur 

angewandten  Seelenkunde,  edited  by  Prof.  Dr.  Sigm.  Freud,  Part  I, 
Leipzic  and  Vienna,  F,  Deuticke,  1908. 

28.  Hysterische  Phantasicn  und  ihrc  Beziehung  zur  Bisexualitat.    Zeitschr. 

f,  Sexualwissenschaft,  Nr.  I,  Part  i,  1908.     (Kl.  Schr.  II.) 

29.  Charakter  und  Analerotik.    Psychiatr.-neurol.  Wochenschr.,  9th  Year, 

Nr.  52,  1908.     (Kl.  Schr.  II.) 

30.  Die  "  kulturclle  "  Sexualmoral  und  die  modcrne  Nervositat.    "  Sexual- 

probleme,"  der  Zeitschrift  "  Mutterschutz "  neue  Folge.  4th  Year, 
1908.     (Kl.  Schr.  II.) 

31.  Der  Dichter  und  das  Phantasieren.    Neue  Revue,  1st  Year,  2d  part  of 

March,  1908.     (Kl.  Schr.  II.) 

32.  Uber   infantile   Sexualtheorien.     "  Scxualprobleme,"  4th  Year,   1908. 

(Kl.  Schr.  II.) 


152  FREUD  S   THEORY   OF  THE   NEUROSES 

33.  Allgemeines   fiber   den   hysteri'schen    Anfall.     Zeitschrift    f.    Psycho- 

therapie  und  med.  Psychologic,  ist  year,  1909.     (Kl.  Schr.  II.) 

34.  Sammlung  kleiner  Schriften  zur  Neurosenlehre.    2d  ed.,  1909.    Vienna 

and  Leipzic,  F.  Deuticke.     (Kl.  Schr.  II.) 

35.  Analyse  der  Phobic  eines  fiinfjahrigen  Knaben.    Jahrbuch  f.  psycho- 

analytischc  und  psychopathologische  Forschungen.  Edited  by  Prof. 
Dr.  E.  Bleulcr  and  Prof.  Dr.  S.  Freud.  Special  editor,  Dozent  Dr. 
C.  G.  Jung,  Vol.  I,  1909.    F.  Deuticke. 

36.  Bemerkungen  uber  einen  Fall  von  Zwangsneurose.    Ebenda. 

37.  Uber   Psychoanalyse.     Five   lectures   delivered   at  the  20  year  anni- 

versary of  Clark  Univ.,  Worcester,  Mass.,  Sep.,  1909.  Leipzic  and 
Vienna,  F.  Deuticke,  1910. 

38.  Die  psychogene  Sehstorung  in  psychoanalytischer  Auffassung.    Arzt- 

Hche  Standeszeitung,  1910,  Nr.  9. 

39.  Eine  Kindheitserinnerung  des  Leonardo  da  Vinci.     7th  Part  of  the 

Schr.  zur  angew.  Seelenkunde.    Vienna  and  Leipzic,  1910. 

40.  Uber  den  Gegensinn  der  Urworte.    Review  of  the  book  of  same  name 

by  Dr.  phil.  Karl  Abel,  (1884)  Jahrb.,  Vol.  II,  Part  i,  1910. 

41.  Die  zukunftigen  Chancen  der  Psychoanalyse.    Zentralblatt  f.  Psycho- 

analyse, 1910,  Part  I.  Edited  by  Prof.  Dr.  S.  Freud.  Spec,  editors, 
Dr.  A.  Adler  and  Dr.  W.  Stekel.    Pub.  J.  F.  Bergmann,  Wiesbaden. 


REVIEW  OF   FREUD  S  WRITINGS  153 

FREUDIAN  LITERATURE  IN  ENGLISH 

A.  A.  Brill:  Psychological  Factors  in  Dementia  Praecox,  Journal  of 
Abnormal  Psychology,  1908.  A  Case  of  Schizophrenia  (Dementia  Prae- 
cox), Amer.  Journal  of  Insanity,  July,  1909.  Freud's  Conceptions  of  the 
Psychoneuroses,  Med.  Record,  Dec,  1909.  A  Contribution  to  the  Psycho- 
pathology  of  Everyday  Life,  Psychotherapy,  1909.  Dreams  and  their 
Relation  to  the  Neurosis,  N.  Y.  Med.  Journal,  Apr.,  1910.  The  Anxiety 
Neuroses,  Journal  of  Abnormal  Psychology,  1910.  Freud's  Theory  of 
Wit,  Journal  of  Abnormal  Psychology,  191 1.  Psychological  Mechanisms 
of  Paranoia,  N.  Y.  Med.  Journal,  Dec,  191 1.  Freud's  Theory  of  the 
Compulsion  Neurosis,  Amer.  Medicine,  Dec,  191 1.  Hysterical  Dreamy 
States;  their  Psychological  Mechanism,  N.  Y.  Med.  Journal,  May,  1912. 
A  Few  Remarks  on  the  Technique  of  Psychoanalysis,  Med.  Review  of 
Reviews,  Apr.,  1912.  The  Only  or  Favorite  Child  in  Adult  Life,  N.  Y. 
State  Med.  Journal,  Aug.,  1912.  Anal  Eroticism  and  Character,  Journal 
of  Abnormal  Psychology,  Aug.-Sep.,  1912.  The  CEdipus  Complex;  its 
Relation  to  the  Psychoneuroses,  Neuroses  and  Psychosexual  Impotence, 
N.  Y.  Med.  Journal,  Oct.,  1912.  Psycho-analysis;  its  Theories  and  Prac- 
tical Application   (Book),  Saunders  Pub.  Co.,  Phila.,   1912. 

Ferenczi :  The  Psycho-analysis  of  Dreams,  Amer.  Journal  of  Psy- 
chology, Apr.,  1910. 

Freud :  Selected  Papers  on  Hysteria  and  other  Psychoneuroses,  Trans- 
lation by  Dr.  A.  A.  Brill  (Journal  of  Nervous  and  Mental  Disease  Mono- 
graph Series),  2d  ed.,  1912.  The  Origin  and  Development  of  Psycho- 
analysis, Amer.  Journal  of  Psychology,  Apr.,  1910.  Three  Contributions 
to  the  Sexual  Theory.  Translation  by  Dr.  A.  A.  Brill  (Journal  of  Ner- 
vous and  Mental  Disease  Monograph  Series),  1910.  Freud's  Interpreta- 
tion of  Dreams,  Translation  by  Dr.  Brill,  MacMillan  Co.,  N.  Y.,  and  Geo. 
Allen,  London,  1912. 

Trigant  Burrow:  Freud's  Psychology  in  its  Relation  to  the  Neuroses, 
American  Journal  of  the  Medical  Sciences,  June,  191 1.  Some  Psycho- 
logical Phases  of  Medicine,  Journal  of  Abnormal  Psychology,  August- 
September,  191 1.  Conscious  and  Unconscious  Mentation  from  the  Psycho- 
analytic Viewpoint,  Psychological  Bulletin,  Vol.  IX,  No.  4,  Apr.  15,  1912. 
Psychology   and    Society,    Journal   of   Abnormal    Psychology,   Jan.-Feb., 

1913- 

Ernest  Jones:  Rationalization  in  Everyday  Life,  Journal  of  Abnormal 
Psychology,  Aug.-Sep.,  1908.  Psycho-analysis  in  Psychotherapy,  Journal 
of  Abnormal  Psychology,  June-July,  1909.  Remarks  on  a  Case  of  Com- 
plete Auto-Psychic  Amnesia,  Journal  of  Abnormal  Psychology,  Aug.-Sep., 

1909.  Psycho-analytic  Notes  on  a  Case  of  Hypomania,  Amer.  Journal  of 
Insanity,  Oct.,  1909.    On  the  Nightmare,  Amer.  Journal  of  Insanity,  Jan., 

1910.  The  CEdipus  Complex  as  an  Explanation  of  Hamlet's  Mystery, 
Amer.  Journal  of  Psychology,  Jan.,  1910.  Freud's  Psychology,  Psycho- 
logical Bulletin,  Apr.,  1910.  Freud's  Theory  of  Dreams,  Amer.  Journal 
of  Psychology,  Apr.,  1910.    The  Psycho-analytic  Method  of  Treatment, 


154  freud's  theory  of  the  neuroses 

Journal  of  Nervous  and  Mental  Disease,  May,  1910.  The  Mental  Char- 
acteristics of  Chronic  Epilepsy,  Maryland  Med.  Journal,  June,  1910.  The 
Therapeutic  Effect  of  Suggestion,  Canadian  Med.  and  Surg.  Journal, 
Feb.,  191 1.  Papers  on  Psycho-analysis,  Baillere,  Tindall  &  Cox,  London, 
1912. 

Jung :  The  Psychology  of  Dementia  Prsecox.  Translation  by  Drs. 
Peterson  and  Brill  (Journal  of  Nervous  and  Mental  Disease  Monograph 
Series,  No.  3,  1909).  The  Association  Method,  Amer.  Journal  of  Psy- 
chology, Apr.,  1910.  Psycho-physical  Investigations  with  the  Galvanom- 
eter and  Pneumograph  on  Normal  and  Insane  Individuals  (with  Peter- 
son), Brain,  July,  1907. 

J.  J.  Putnam :  Personal  Experiences  of  Sigmund  Freud  and  His  Work, 
Journal  of  Abnormal  Psychology,  Dec,  1909,  and  Jan.-Mar.,  1910.  On  the 
Etiology  and  Treatment  of  the  Psychoneuroses,  Boston  Med.  and  Surg. 
Journal,  July  21,  1910.  A  Plea  for  the  Study  of  Philosophic  Methods  in 
Preparation  for  Psycho-analytic  Work.  Journal  of  Abnormal  Psychology, 
Oct.-Nov.,  191 1.  On  Freud's  Psycho-anal3i:ic  Method  and  its  Evolution 
(Harvey  Lecture),  Boston  Med.  and  Surg.  Journal,  Jan.  25,  1912,  and 
Volume  of  Harvey  Lectures  for  1911-1912.  Comments  on  Sex  Issues 
from  the  Freudian  Standpoint,  New  York  Medical  Journal,  June  22,  1912. 

William  A.  White :  Mental  Mechanisms,  Monograph  Series,  Journal  of 
Nervous  and  Mental  Disease. 


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